[Cervical ripening with misoprostol with a live fetus]

To evaluate the effectiveness and safety of misoprostol for cervical ripening or induction of labor at term.

A critical review of studies identified from searches of PubMed and the Cochrane libraries using the following keywords: "misoprostol", "cervical ripening", "epidemiology", "pregnancy outcome", "maternal morbidity", "perinatal death".

Vaginal misoprostol in doses of 25 μg three- to six-hourly was similar as dinoprostone in effectiveness (caesarean section rate or vaginal delivery in 24 hours) (LE1) and risks (uterine hyperstimulation, adverse neonatal outcome, uterine rupture, maternal side-effects) (LE1). Published medico-economic studies are not sufficient to evaluate a potential profit to the use of vaginal misoprostol 25 μg (Avis d'Experts). The use of misoprostol in women with prior cesarean delivery or major uterine surgery has been associated with an increase in uterine rupture and therefore should be avoided (LE4).

Review of the current literature favors the use of vaginal misoprostol 25 μg three- to six-hourly equally to dinoprostone accordingly with previous French and international guidelines (World Health Organization and American College of Obstetricians and Gynecologist). The use of misoprostol 25 μg supposes a preparation by the pharmacist to ensure the safety of this precise posology. Medico-economic studies are warranted to attest an economic profit to the use of misoprostol 25 μg in comparison to dinoprostone.