Effect of misoprostol versus oxytocin during caesarean section: a systematic review and meta-analysis
Article first published online: 18 JAN 2013
© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 120, Issue 5, pages 531–540, April 2013
How to Cite
Effect of misoprostol versus oxytocin during caesarean section: a systematic review and meta-analysis. BJOG 2013;120:531–540., , , , .
- Issue published online: 11 MAR 2013
- Article first published online: 18 JAN 2013
- Manuscript Accepted: 29 NOV 2012
- Shanghai Natural Science Foundation. Grant Number: 11ZR1428100
- Blood loss;
- caesarean section;
- side effects
The efficacy of misoprostol versus oxytocin for reducing blood loss during caesarean section remains unclear.
To conduct a meta-analysis comparing the efficacy of misoprostol with that of oxytocin in reducing blood loss during caesarean section.
We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov for randomised controlled trials (RCTs) using the keywords ‘misoprostol’, ‘oxytocin’ and ‘caesarean section’.
Refereed publications examining the efficacy of misoprostol and oxytocin for reducing blood loss during caesarean section.
Data collection and analysis
Two of the authors independently abstracted data from original articles. A fixed-effects or random-effects model was used, depending on the heterogeneity of the data, to estimate the risk ratio (RR), risk difference (RD) or weighted mean difference (WMD) with 95% confidence intervals (95% CIs).
A total of 646 pregnant women were included in this analysis. There was a significant difference in estimated blood loss between the misoprostol and the oxytocin groups (WMD–64.09; 95% CI−119.86–−8.31). However, differences in haemoglobin levels (WMD–0.04; 95% CI−0.18–0.10), additional oxytocic therapy requirements (RD .03; 95% CI −0.04–0.10) and blood transfusion requirements (RD 0.00; 95% CI−0.03–0.02) between the two groups failed to reach statistical significance. The incidence of postoperative shivering/pyrexia was significantly higher in the misoprostol group, compared with the oxytocin group (RR 3.23; 95% CI 1.41–7.39).
The results suggest that misoprostol is as effective as oxytocin for reducing blood loss during caesarean section. However, further research into treatment strategies is needed.