Oral Misoprostol for Induction of Labour: An Initial Australian Experience

Misoprostol, a prostaglandin E1 analogue, is widely used internationally for the induction of labour (IOL) but was recently approved in Australia in a 25-μg oral tablet form (Angusta). While previous studies suggest oral misoprostol may reduce Caesarean section rates secondary to uterine hyperstimulation compared to vaginal Dinoprostone, its efficacy and feasibility in an Australian clinical setting remain unclear. This study evaluates the implementation of oral misoprostol for the IOL in multiparous women at a tertiary maternity hospital.

To assess the clinical outcomes, patient satisfaction, and resource implications of introducing oral misoprostol for labour induction, comparing it to the established vaginal Prostaglandin E2 (PGE2) protocol.

A clinical protocol for oral misoprostol induction was developed following a literature review and expert consultation. A retrospective service evaluation was conducted after the first 100 patients, comparing key labour and birth outcomes between oral misoprostol and historical vaginal PGE2 cohorts. Data were extracted from hospital records, and propensity score matching was applied to balance baseline characteristics. Patient satisfaction was assessed via a survey.

No significant differences were found in induction-to-delivery time, mode of birth, oxytocin use or adverse neonatal outcomes. Epidural use was higher in the oral misoprostol group. Medication costs and staffing requirements were also increased. Patient satisfaction was comparable between groups.

In a setting with an early artificial rupture of membranes (ARM) protocol, oral misoprostol did not provide clear advantages over vaginal PGE2. Further research is needed to optimise induction protocols in the Australian context.