TITLE:
Safety of Misoprostol in Labor Induction for Twin Pregnancies: A Systematic Review
AUTHORS:
Mamour Gueye, Amani Hoballah, Hened Hage Ali, Fama Katy Wade, Diarra Biaye, Hélène Maty Gning, Aicha Guisse, Aissatou Mbodji
KEYWORDS:
Misoprostol, Twin Pregnancy, Labor Induction, Maternal Outcomes, Neonatal Outcomes, Systematic Review
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.15 No.4,
April
27,
2025
ABSTRACT: Objectives: To evaluate the safety of using misoprostol for labor induction in twin pregnancies. Methodology: To address the research question regarding the safety and efficacy of misoprostol for labor induction in twin pregnancies, a systematic review was conducted. An extensive search strategy was employed, identifying relevant studies published in English or French between January 1, 1990, and December 12, 2023. Inclusion criteria focused on twin pregnancies with viable fetuses, a gestational age of 34 weeks or more, and the absence of uterine scars. Data extraction was performed using a standardized form, and the results of the selected studies were analyzed and synthesized. Results: Five retrospective cohort studies, comprising a total of 1,205 participants, were included in the review. These studies examined the effects of misoprostol for labor induction in twin pregnancies compared to spontaneous labor, oxytocin, dinoprostone, or elective cesarean section. The findings indicated that labor induction in twin pregnancies, particularly with misoprostol, did not significantly increase the risk of adverse maternal or neonatal outcomes. No notable differences were observed in terms of maternal morbidity, cesarean section rates, or neonatal outcomes, such as low Apgar scores at five minutes and umbilical artery pH values. Conclusion: This systematic review suggests that the use of misoprostol for labor induction in twin pregnancies may be a safe and effective option. However, the decision to induce labor should be made on a case-by-case basis, considering the individual clinical context and patient preferences. Existing controversies in the literature highlight the need for further research, including multicenter studies and randomized clinical trials, to provide clear guidelines for clinicians.