{Reference Type}: Journal Article
{Title}: Vaginal misoprostol versus vaginal dinoprostone for cervical ripening and induction of labour: An individual participant data meta-analysis of randomised controlled trials.
{Author}: Patabendige M;Chan F;Vayssiere C;Ehlinger V;Van Gemund N;le Cessie S;Prager M;Marions L;Rozenberg P;Chevret S;Young DC;Le Roux PA;Gregson S;Waterstone M;Rolnik DL;Mol BW;Li W;
{Journal}: BJOG
{Volume}: 131
{Issue}: 9
{Year}: 2024 Aug 29
{Factor}: 7.331
{DOI}: 10.1111/1471-0528.17794
{Abstract}: <B>BACKGROUND: </B>Induction of labour (IOL) is common practice and different methods carry different effectiveness and safety profiles.<BR><B>OBJECTIVE: </B>To compare the effectiveness, and maternal and perinatal safety outcomes of IOL with vaginal misoprostol versus vaginal dinoprostone using individual participant data from randomised clinical trials.<BR><B>METHODS: </B>The following databases were searched from inception to March 2023: CINAHL Plus, ClinicalTrials.gov, Cochrane Pregnancy and Childbirth Group Trial Register, Ovid Embase, Ovid Emcare, Ovid MEDLINE, Scopus and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP).<BR><B>METHODS: </B>Randomised controlled trials (RCTs), with viable singleton gestation, no language restrictions, and all published and unpublished data.<BR><B>METHODS: </B>An individual participant data meta-analysis was carried out.<BR><B>RESULTS: </B>Ten of 52 eligible trials provided individual participant data, of which two were excluded after checking data integrity. The remaining eight trials compared low-dose vaginal misoprostol versus dinoprostone, including 4180 women undergoing IOL, which represents 32.8% of all participants in the published RCTs. Of these, 2077 were assigned to low-dose vaginal misoprostol and 2103 were assigned to vaginal dinoprostone. Compared with vaginal dinoprostone, low-dose vaginal misoprostol had a comparable rate of vaginal birth. Composite adverse perinatal outcomes did not differ between the groups. Compared with vaginal dinoprostone, composite adverse maternal outcomes were significantly lower with low-dose vaginal misoprostol (aOR 0.80, 95% CI 0.65-0.98, P = 0.03, I2 = 0%).<BR><B>CONCLUSIONS: </B>Low-dose vaginal misoprostol and vaginal dinoprostone for IOL are comparable in terms of effectiveness and perinatal safety. However, low-dose vaginal misoprostol is likely to lead to a lower rate of composite adverse maternal outcomes than vaginal dinoprostone.