Evidence map›Paper›PMID 40357798›Full record

SynthesisBJOG : an international journal of obstetrics and gynaecology2025

Misoprostol Versus Oxytocin for the Prevention of Postpartum Haemorrhage: A Systematic Review and Meta-Analysis Including Individual Participant Data.

Madeline Flanagan, Nicole Au, Malitha Patabendige, Arsheeya Rattan, Ritwik Samanta, Daljit Sahota, Enrique Teran, Vanita Jain, Abdulkarim O Musa, Munir'deen A Ijaiya and 3 more

Abstract readSystematic ReviewMeta-AnalysisComparative Study
In one paragraph

Synthesis in BJOG : an international journal of obstetrics and gynaecology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Madeline FlanaganDepartment of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.ORCID https://orcid.org/0000-0001-8371-3126
Nicole AuDepartment of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.
Malitha PatabendigeDepartment of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.
Arsheeya RattanDepartment of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.
Ritwik SamantaDepartment of Obstetrics and Gynaecology, Kothari Medical Centre, Kolkata, West Bengal, India.
Daljit SahotaDepartment of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.ORCID https://orcid.org/0000-0002-3755-2701
Enrique TeranColegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador.
Vanita JainDepartment of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Abdulkarim O MusaDepartment of Obstetrics and Gynecology, Federal Medical Centre, Lokoja, Nigeria.
Munir'deen A IjaiyaDepartment of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Ilorin, Ilorin, Nigeria.
Daniel L RolnikDepartment of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.
Wentao LiDepartment of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.ORCID https://orcid.org/0000-0001-8980-0909
Ben W MolDepartment of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.ORCID https://orcid.org/0000-0001-8337-550X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPostpartum haemorrhage (PPH) is the leading cause of maternal mortality. Uterotonics are the mainstay of PPH prevention.

objectivesTo compare the efficacy of misoprostol and oxytocin for the prevention of PPH and to evaluate the trustworthiness of these randomised controlled trials (RCTs). SEARCH STRATEGY AND SELECTION CRITERIA: Seven databases were searched for peer-reviewed literature meeting the inclusion criteria of RCTs comparing misoprostol and oxytocin for the prevention of PPH. DATA COLLECTION AND ANALYSIS: Data were collected by two independent reviewers. Individual participant data (IPD) were meta-analysed for outcomes PPH ≥ 500 and ≥ 1000 mL. RCTs that did not share IPD were classified as trustworthy or not, and aggregate data were meta-analysed according to trustworthiness. MAIN

resultsOf 79 eligible RCTs, 10 (12.7%) provided IPD, of which 6 were included. Analysis of IPD showed PPH ≥ 500 mL to be significantly higher in the misoprostol than in the oxytocin group (2022 participants, aOR 1.84, 95% CI 1.43-2.34). For PPH ≥ 1000 mL, analysis of IPD showed that misoprostol and oxytocin were comparable (2022 participants, OR 1.14, 95% CI 0.68-1.91). Of the 69 studies that did not provide IPD, 23 (33.3%) were assessed as trustworthy. Analysis of trustworthy data (IPD and 23 aggregate data RCTs) showed no difference between misoprostol and oxytocin for PPH ≥ 500 mL (24 334 participants, OR 1.01, 95% CI 0.69-1.49), while misoprostol was associated with a significantly increased risk of PPH ≥ 1000 mL compared to oxytocin (25 249 participants, OR 1.36, 95% CI 1.16-1.59).

conclusionsOf 79 RCTs comparing misoprostol and oxytocin for the prevention of PPH, 36.7% met trustworthiness criteria. Oxytocin is comparable to misoprostol for preventing PPH and may be superior for preventing severe PPH.

Indexed as

MisoprostolOxytocicsOxytocinPostpartum HemorrhageFemaleHumansPregnancyRandomized Controlled Trials as TopicMisoprostolOxytocicsOxytocinactive management of third‐stage labour (AMSTL)individual‐participant data meta‐analysis (IPD‐MA)meta‐analysismisoprostoloxytocinpostpartum haemorrhage (PPH)prevention

Identifiers

PMID40357798
PMCPMC12315072

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.