Buccal or sublingual misoprostol for cervical ripening and induction of labour

Gibson Muzonzini; G Justus Hofmeyr

doi:10.1002/14651858.CD004221.pub2

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Analysis 1.1

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 1 Vaginal delivery not achieved in 24 hours.

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Analysis 1.2

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 2 Uterine hyperstimulation with fetal heart rate changes.

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Analysis 1.3

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 3 Caesarean section.

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Analysis 1.5

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 5 Serious maternal morbidity or death.

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Analysis 1.6

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 1.7

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 7 Oxytocin augmentation.

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Analysis 1.10

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 10 Epidural analgesia.

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Analysis 1.11

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 11 Instrumental vaginal delivery.

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Analysis 1.13

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 1.14

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 14 Neonatal intensive care unit admission.

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Analysis 1.24

Comparison 1 Subligual/buccal vs vaginal misoprostol: all women, Outcome 24 Serious maternal complication.

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Analysis 10.1

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 1 Vaginal delivery not achieved within 24 hours.

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Analysis 10.2

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 2 Uterine hyperstimulation with fetal heart rate changes.

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Analysis 10.3

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 3 Caesarean section.

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Analysis 10.6

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.

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Analysis 10.7

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 7 Oxytocin augmentation.

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Analysis 10.8

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 8 Uterine hyperstimulation without fetal heart rate changes.

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Analysis 10.10

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 10 Epidural analgesia.

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Analysis 10.11

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 11 Instrumental vaginal delivery.

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Analysis 10.13

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 13 Apgar score < 7 at 5 minutes.

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Analysis 10.14

Comparison 10 Subligual/buccal vs oral misoprostol: all women, Outcome 14 Neonatal intensive care unit admission.

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Comparison 1. Subligual/buccal vs vaginal misoprostol: all women

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved in 24 hours Show forest plot	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.91, 1.63]

2 Uterine hyperstimulation with fetal heart rate changes Show forest plot	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	1.47 [0.80, 2.71]

3 Caesarean section Show forest plot	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	0.70 [0.42, 1.15]

5 Serious maternal morbidity or death Show forest plot	1	152	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

6 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	3.24 [0.13, 78.38]

7 Oxytocin augmentation Show forest plot	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.84, 1.34]

10 Epidural analgesia Show forest plot	1	152	Odds Ratio (M‐H, Fixed, 95% CI)	1.21 [0.57, 2.56]

11 Instrumental vaginal delivery Show forest plot	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	0.36 [0.10, 1.28]

13 Apgar score < 7 at 5 minutes Show forest plot	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	9.73 [0.53, 177.64]

14 Neonatal intensive care unit admission Show forest plot	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	1.19 [0.54, 2.64]

24 Serious maternal complication Show forest plot	1	152	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Subligual/buccal vs vaginal misoprostol: all women

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Comparison 10. Subligual/buccal vs oral misoprostol: all women

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Vaginal delivery not achieved within 24 hours Show forest plot	2	349	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.68, 1.11]

1.1 Same dose	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.63 [0.34, 1.16]
1.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.73, 1.22]
2 Uterine hyperstimulation with fetal heart rate changes Show forest plot	2	349	Risk Ratio (M‐H, Fixed, 95% CI)	1.39 [0.28, 6.96]

2.1 Same dose	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.13, 71.92]
2.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.14, 6.93]
3 Caesarean section Show forest plot	2	349	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.57, 1.19]

3.1 Same dose	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.25, 1.14]
3.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.63, 1.47]
6 Cervix unfavourable/unchanged after 12‐24 hours Show forest plot	2	349	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.03, 1.14]

6.1 Same dose	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.09 [0.01, 1.60]
6.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.50 [0.05, 5.40]
7 Oxytocin augmentation Show forest plot	2	349	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.68, 1.07]

7.1 Same dose	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.45, 1.21]
7.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.70, 1.16]
8 Uterine hyperstimulation without fetal heart rate changes Show forest plot	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	2.48 [0.49, 12.54]

8.1 Same dose	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	2.48 [0.49, 12.54]
10 Epidural analgesia Show forest plot	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.66, 1.29]

10.1 Same dose	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.93 [0.66, 1.29]
11 Instrumental vaginal delivery Show forest plot	2	349	Risk Ratio (M‐H, Fixed, 95% CI)	1.28 [0.87, 1.88]

11.1 Same dose	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	1.57 [0.66, 3.72]
11.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	1.20 [0.78, 1.86]
13 Apgar score < 7 at 5 minutes Show forest plot	2	349	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.06, 15.68]

13.1 Same dose	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.99 [0.06, 15.68]
14 Neonatal intensive care unit admission Show forest plot	2	349	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.44, 1.47]

14.1 Same dose	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.27, 2.55]
14.2 Bigger dose orally	1	249	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.39, 1.63]

Comparison 10. Subligual/buccal vs oral misoprostol: all women

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