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  • Title: Effect of misoprostol versus oxytocin during caesarean section: a systematic review and meta-analysis.
    Author: Hua J, Chen G, Xing F, Scott M, Li Q.
    Journal: BJOG; 2013 Apr; 120(5):531-40. PubMed ID: 23331998.
    Abstract:
    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.
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