Misoprostol sublingual é mais seguro e eficaz no tratamento de hemorragia pós-parto vaginal? Revisão sistemática e metanálise

OBJECTIVE: This systematic review and meta-analysis aimed to assess the effectiveness of sublingual misoprostol compared to oxytocin in the treatment of postpartum vaginal delivery bleeding. METHODS: Searches were conducted on PubMed, Cochrane, and Embase up to Jul 25, 2024. The search strategy utilized Medical Subject Headings terms and accessible text terms. No language limitations were applied. The inclusion criteria comprised randomized controlled trials (RCTs) involving women who underwent postpartum vaginal delivery and received sublingual misoprostol or oxytocin within the same timeframe. Exclusions included cesarean delivery, alternative routes of misoprostol administration, combination with other drugs, or labor induction. Outcomes analyzed included postpartum hemorrhage, hemoglobin reduction, and side effects between the two groups. Three independent reviewers decided on abstracts, full texts, and data extraction. Meta-analysis employed Review Manager software, calculating odds ratios for dichotomous data and weighted mean differences, with 95% confidence intervals for continuous data. Among 217 studies, 10 met the inclusion criteria, involving 5,041 pregnant women. RESULTS: Sublingual misoprostol-treated postpartum hemorrhage in 2,517 (49.9%) patients. Fever (OR 6.05; 95% CI 2.63-13.91; P<0.0001; I2=87%) and shivering (OR 5.04; 95% CI 2.76-9.20; P<0.00001; I2=91%) were significantly high with misoprostol. No significant differences were found between sublingual misoprostol and oxytocin for postpartum hemorrhage (OR 0.55; 95% CI 0.15-2.02; P=0.37; I2=95%) or hemoglobin decline (OR 0.44; 95% CI 0.15-1.31; P=0.14; I2=97%). CONCLUSION: Oxytocin appears to be a safer and more effective alternative than sublingual misoprostol for treating postpartum hemorrhage in vaginal deliveries, with an associated increase in side effects with the latter.