Cost‐effectiveness analysis of vaginal misoprostol versus dinoprostone pessary: A non‐inferiority large randomized controlled trial in France

Mounié, Michaël; Costa, Nadège; Gaudineau, A.; Molinier, Laurent; Vayssière, Christophe; Derumeaux, Hélène

doi:10.1002/ijgo.13999

Intl J Gynecology & Obste

2021

DOI: 10.1002/ijgo.13999

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Cost‐effectiveness analysis of vaginal misoprostol versus dinoprostone pessary: A non‐inferiority large randomized controlled trial in France

Michaël Mounié

Nadège Costa

A. Gaudineau

et al.

Abstract: Induction of labor (IOL) is a common procedure, performed for approximately 40% of nulliparous and 30% of multiparous women. 1 It is recommended for women with a medical indication and may be justified after 39 weeks of gestation to improve the safety for mothers as well as infants. 2,3 At present, the drug of reference for induction is slow-release dinoprostone (PGE2). 4 In comparison, misoprostol, a synthetic analog of prostaglandin E1 (PGE1) is a less expensive, thermostable,

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Efficacy and safety of misoprostol compared with dinoprostone for labor induction at term: an updated systematic review and meta-analysis of randomized controlled trials

Lakho,

Hyder,

Ashraf

et al. 2024

Front. Med.

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BackgroundLabor induction is a common obstetric intervention, increasingly performed worldwide, often using prostaglandins like misoprostol and dinoprostone.ObjectiveThis study aims to compare the effectiveness and safety of intravaginal misoprostol versus dinoprostone for inducing labor, examining their impact on various maternal and neonatal outcomes.MethodsA systematic review and meta-analysis were conducted using four databases—PubMed, Google Scholar, EBSCO, and the Cochrane Library—from January 2000 to April 2023. We included randomized controlled trials (RCTs) involving singleton pregnancies at term (37–42 weeks) with unfavorable cervices, where intravaginal misoprostol was compared to dinoprostone. Key outcomes evaluated for effectiveness included vaginal delivery within 24 h, overall vaginal delivery rate, and need for oxytocin augmentation. Safety outcomes assessed were tachysystole, uterine hyperstimulation, abnormal cardiotocography, NICU admissions, cesarean delivery, and APGAR scores. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model in Review Manager (RevMan) version 5.4.1.ResultsEight RCTs with a total of 1,801 participants (937 in the misoprostol group and 864 in the dinoprostone group) met the inclusion criteria. Misoprostol required a significantly less oxytocin augmentation than dinoprostone [RR = 0.83; 95% CI (0.71, 0.97), p = 0.02]. Other outcomes, including rates of cesarean delivery, uterine tachysystole, hyperstimulation, and NICU admissions, showed no significant differences between the two groups, indicating comparable safety and efficacy profiles.ConclusionThis meta-analysis demonstrates that intravaginal misoprostol is an effective and safe alternative to dinoprostone for labor induction at term. Misoprostol achieved comparable efficacy and safety outcomes while requiring less oxytocin augmentation, supporting its potential as a practical induction agent in clinical settings.

show abstract

Efficacy and safety of misoprostol compared with dinoprostone for labor induction at term: an updated systematic review and meta-analysis of randomized controlled trials

Lakho,

Hyder,

Ashraf

et al. 2024

Front. Med.

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show abstract

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Cost‐effectiveness analysis of vaginal misoprostol versus dinoprostone pessary: A non‐inferiority large randomized controlled trial in France

Cited by 1 publication

References 25 publications

Efficacy and safety of misoprostol compared with dinoprostone for labor induction at term: an updated systematic review and meta-analysis of randomized controlled trials

Efficacy and safety of misoprostol compared with dinoprostone for labor induction at term: an updated systematic review and meta-analysis of randomized controlled trials

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