背景:前列腺素E2(PGE2)和催产素以及引产(IOL)之间的比较仍存在争议。
目的:本研究旨在确定这两种药物在IOL中的安全性和有效性。
方法:PubMed,Embase,WebofScience,科克伦图书馆,和ClinicalTrials.gov.从数据库建立到2023年4月23日。
方法:使用关键字“劳动力,归纳法,前列腺素E2/PGE2/地诺前列酮,和催产素\”。仅在至少晚期早产(胎龄[GA]≥34周)的女性中比较催产素和阴道地诺前列酮的随机临床试验,单身怀孕,并且具有完整的膜被纳入进一步的荟萃分析。
方法:我们进行了描述性分析和荟萃分析。在荟萃分析中,我们利用Mantel-Haenszel随机效应模型来分析二分数据,采用相对风险(RR)和95%置信区间(CI)作为效应测度。使用CochraneCollaboration的偏倚风险评估工具(RoB2)评估研究质量。采用随机效应模型进行荟萃分析。
结果:在从五个数据库中筛选3303篇文章之后,共纳入了由1071例患者组成的9项随机对照研究.我们的分析包括PGE2组的534例患者和催产素组的537例患者。PGE2诱导后阴道分娩的汇总估计值为84.2%,而在催产素诱导后,是79.8%。荟萃分析显示,两组在阴道分娩率方面没有统计学差异(汇总RR,1.05;95%CI:0.95-1.16;Q的P值,0.001;I2,71.14%),剖宫产(合并RR,0.84;95%CI:0.52-1.35;Q的P值,0.007;I2,61.69%)和诱导-分娩间隔(汇总标准平均差,0.09;95%CI:-0.67至0.85;Q的P值,0.000;I2,96.45%)。由于胎儿窘迫和子宫过度刺激的结果在所有入选研究中都是一致的,未进行进一步的荟萃分析.
结论:合并现有文献时,这意味着在GA≥36周的孕妇中,发现缩宫素对分娩结局和安全性问题的影响与PGE2相似.虽然子宫颈不好,低剂量和高剂量催产素用于IOL均可行.
BACKGROUND: The comparison between prostaglandin E2 (PGE2) and oxytocin and for induction of labor (IOL) remains controversial.
OBJECTIVE: The present study aimed to determine the safety and efficacy of these two agents in IOL.
METHODS: PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov. from the establishment of the database to April 23, 2023.
METHODS: A search was conducted with keywords \"labor, induction, prostaglandin E2/PGE2/dinoprostone, and oxytocin\". Only randomized clinical trials comparing oxytocin and vaginal dinoprostone in women who were at least late preterm (gestational age [GA] ≥34 weeks), singleton pregnant, and had intact membranes were enrolled for further meta-analysis.
METHODS: We conducted both a descriptive analysis and a meta-analysis. In the meta-analysis, we utilized the Mantel-Haenszel random effects model to analyze dichotomous data, employing the relative risk (RR) as the effect measure along with 95% confidence intervals (CIs). The study quality was evaluated using Cochrane Collaboration\'s risk of bias assessment tool (RoB 2). A random-effects model was applied for the meta-analysis.
RESULTS: After screening 3303 articles from five databases, a total of nine randomized controlled studies composed of 1071 patients were included. Our analysis included 534 patients in the PGE2 group and 537 patients in the oxytocin group. The pooled estimate of vaginal deliveries following PGE2 induction stood at 84.2%, while after oxytocin induction, it was 79.8%. The meta-analysis showed no statistical difference between the two groups in terms of the rate of vaginal delivery (pooled RR, 1.05; 95% CI: 0.95-1.16; P value for Q, 0.001; I2, 71.14%), cesarean section (pooled RR, 0.84; 95% CI: 0.52-1.35; P value for Q, 0.007; I2, 61.69%) and induction-delivery interval (pooled standard mean difference, 0.09; 95% CI: -0.67 to 0.85; P value for Q, 0.000; I2, 96.45%). Since the results for fetal distress and uterine hyperstimulation were consistent across all enrolled studies, no further meta-analysis was conducted.
CONCLUSIONS: When amalgamating the available literature, it implies that oxytocin was found to have similar effects as PGE2 on delivery outcomes and safety concerns in pregnant women with GA ≥36 weeks. Although the uterine cervix was unfavorable, both low and high doses of oxytocin were feasible for IOL.