Effect of misoprostol versus oxytocin during caesarean section: a systematic review and meta-analysis.

BACKGROUND The efficacy of misoprostol versus oxytocin for reducing blood loss during caesarean section remains unclear. OBJECTIVES To conduct a meta-analysis comparing the efficacy of misoprostol with that of oxytocin in reducing blood loss during caesarean section. SEARCH STRATEGY 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'. SELECTION CRITERIA 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). MAIN RESULTS 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). AUTHORS' CONCLUSIONS 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.