Oral Misoprostol Versus Vaginal Dinoprostone for Labor Induction: A Systematic Review and Meta-Analysis

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Abstract

AIM: Pharmacologic cervical ripening is frequently used for labor induction, yet the comparative effectiveness, safety, and resource utilization of available agents remain uncertain. This review compared oral misoprostol with vaginal dinoprostone for labor induction in singleton pregnancies at ≥ 34 weeks' gestation. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials, searching 11 databases to May 2025. Eligible studies compared oral misoprostol with vaginal dinoprostone in singleton pregnancies ≥ 34 weeks undergoing induction without contraindications to vaginal birth. Seven critical outcomes were assessed: cesarean birth, uterine hyperstimulation, 5-min Apgar score < 7, neonatal intensive care unit (NICU) admission, oxytocin augmentation, vaginal birth within 24 h, and induction-to-birth interval. Study selection and data extraction were performed in duplicate. Random-effects meta-analysis was applied, with risk of bias, certainty of evidence, and subgroup credibility assessed using Cochrane RoB 2.0, GRADE, and ICEMAN. RESULTS: Eleven trials including 3783 participants were analyzed. Oral misoprostol was associated with lower cesarean birth (RR 0.83, 95% CI 0.74-0.94) and reduced oxytocin augmentation (RR 0.89, 95% CI 0.82-0.97). Vaginal dinoprostone was associated with higher vaginal birth within 24 h (RR 0.91, 95% CI 0.86-0.96) and a shorter induction-to-birth interval. No significant differences were observed in uterine hyperstimulation, 5-min Apgar score < 7, or NICU admission. CONCLUSION: Oral misoprostol is associated with reduced cesarean birth and probably reduces the need for oxytocin augmentation, while vaginal dinoprostone is associated with higher rates of vaginal birth within 24 h and probably a shorter induction-to-birth interval. Maternal and neonatal safety outcomes appear comparable; these findings support consideration of oral misoprostol in selected populations and settings, while acknowledging underlying clinical and methodological heterogeneity.

Abstract as published, via PubMed.