TABLE 3.

Misoprostol plus oxytocin compared with oxytocin

		Number of events/total number or Total number
Outcome	No of trials	Misoprostol plus oxytocin	Oxytocin	Relative risk or Mean difference (95% CI)	P value	I2 (%)
Primary outcomes
Mean intraoperative blood loss (ml)
Sublingual misoprostol	446,48,50,53	454	456	−139 (−300 to 21)	0.09	99
Oral misoprostol	143	28	25	−29 (−159 to 101)	0.66	NA
Buccal misoprostol	141	173	179	24 (−16 to 64)	0.24	NA
Rectal misoprostol	152	200	200	−191 (−252 to −130)	<0.00001	NA
Mean postoperative blood loss (ml)
Sublingual misoprostol	153	179	187	−265 (−282 to −248)	<0.00001	NA
Oral misoprostol	143	28	25	28 (−30 to 86)	0.34	NA
Rectal misoprostol	152	200	200	−139 (−166 to −112)	<0.00001	NA
Mean fall in hemoglobin (g/dl)
Sublingual misoprostol	346,48,50	275	269	−0.2 (−0.5 to 0.1)	0.13	66
Intrauterine misoprostol	144	100	100	−0.6 (−0.9 to −0.3)	0.0002	NA
Mean fall in hematocrit (%)
Sublingual misoprostol	346,48,53	364	372	−2.1 (−3.4 to −0.8)	0.0001	91
Buccal misoprostol	141	173	179	−0.2 (−0.5 to 0.1)	0.11	NA
Rectal misoprostol	152	200	200	−3.5 (−4.2 to −2.9)	<0.00001	NA
Intrauterine misoprostol	144	100	100	−1.8 (−2.8 to −0.7)	0.001	NA
Use of additional uterotonic agents
Sublingual misoprostol	348,50,53	35/329	102/331	0.33 (0.18 to 0.62)	0.0005	61
Oral misoprostol	143	0/28	0/25	Not estimable	NA	NA
Buccal misoprostol	141	45/173	76/179	0.61 (0.45 to 0.83)	0.002	NA
Rectal misoprostol	152	14/200	36/200	0.39 (0.22 to 0.70)	0.002	NA
Intrauterine misoprostol	144	3/100	6/100	0.50 (0.13 to 1.94)	0.32	NA
Secondary outcomes
Blood loss >500 ml
Sublingual misoprostol	150	73/90	77/84	0.88 (0.79 to 1.00)	0.05	NA
Blood loss >1000 ml
Sublingual misoprostol	346,48,50	25/275	29/269	0.85 (0.52 to 1.39)	0.53	0
Buccal misoprostol	141	24/173	22/179	1.13(0.66 to 1.94)	0.66	NA
Blood transfusion
Sublingual misoprostol	346,50,53	3/394	17/396	0.24 (0.02 to 2.60)	0.24	65
Oral misoprostol	143	0/28	0/25	Not estimable	NA	NA
Buccal misoprostol	141	3/173	3/179	1.03 (0.21 to 5.06)	0.97	NA
Rectal misoprostol	152	0/200	0/200	Not estimable	NA	NA
Intrauterine misoprostol	144	0/100	0/100	Not estimable	NA	NA
Postoperative hemoglobin (g/dl)
Sublingual misoprostol	248,50	150	144	0.1 (−0.4 to 0.6)	0.68	64
Oral misoprostol	143	28	25	−0.5 (−1.3 to 0.3)	0.20	NA
Intrauterine misoprostol	144	100	100	0.6 (0.3 to 0.9)	0.0007	NA
Postoperative hematocrit (%)
Sublingual misoprostol	248,53	239	247	1.4 (−2.2 to 5.0)	0.44	95
Intrauterine misoprostol	144	100	100	1.6 (0.6 to 2.6)	0.002	NA
Shivering
Sublingual misoprostol	446,48,50,53	87/454	43/456	2.01 (1.50 to 2.70)	<0.00001	34
Oral misoprostol	143	10/28	2/25	4.46 (1.08 to 18.45)	0.04	NA
Pyrexia
Sublingual misoprostol	446,48,50,53	44/454	17/456	2.58 (1.50 to 4.45)	0.0006	8
Rectal misoprostol	152	11/200	13/200	0.85 (0.39 to 1.84)	0.67	NA
Intrauterine misoprostol	144	8/100	4/100	2.00 (0.62 to 6.43)	0.24	NA
Nausea
Sublingual misoprostol	346,50,53	52/394	26/396	1.90 (0.87 to 4.17)	0.11	64
Oral misoprostol	143	0/28	1/25	0.30 (0.01 to 7.02)	0.45	NA
Vomiting
Sublingual misoprostol	246,50	20/215	13/209	1.51 (0.78 to 2.95)	0.22	0
Intrauterine misoprostol	144	3/100	3/100	1.00 (0.21 to 4.84)	1.00	NA
Diarrhea
Sublingual misoprostol	153	2/179	0/187	5.22 (0.25 to 108.0)	0.28	NA
Intrauterine misoprostol	144	0/100	0/100	Not estimable	NA	NA
Abdominal pain
Sublingual misoprostol	153	24/179	13/187	1.93 (1.01 to 3.67)	0.04	NA
Intrauterine misoprostol	144	7/100	8/100	0.88 (0.33 to 2.32)	0.79	NA
Headache
Sublingual misoprostol	146	4/125	2/125	2.00 (0.37 to 10.72)	0.42	NA
Oral misoprostol	143	0/28	1/25	0.30 (0.01 to 7.02)	0.45	NA
Any side effect
Sublingual misoprostol	146	48/125	19/125	2.53 (1.58 to 4.04)	0.0001	NA
Apgar score at 1 min
Rectal misoprostol	152	200	200	−0.3 (−0.6 to 0.0)	0.08	NA
Apgar score at 5 min
Rectal misoprostol	152	200	200	0.2 (0.1-0.3)	0.005	NA
NICU admission
Rectal misoprostol	152	6/200	9/200	0.66 (0.23-1.88)	0.43	NA

CI, confidence interval; NA, not applicable; NICU, neonatal intensive care unit