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

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Clinical Pharmacology

Background:

• Pharmacologic cervical ripening is a common method for labor induction.
• The comparative effectiveness and safety of oral misoprostol versus vaginal dinoprostone are not fully understood.

Purpose of the Study:

• To compare oral misoprostol with vaginal dinoprostone for labor induction in singleton pregnancies.
• To evaluate differences in effectiveness, safety, and resource utilization.

Main Methods:

• Systematic review and meta-analysis of 11 randomized controlled trials (3783 participants).
• Searched 11 databases up to May 2025 for studies comparing oral misoprostol and vaginal dinoprostone.
• Assessed seven critical outcomes including cesarean birth, uterine hyperstimulation, Apgar scores, NICU admission, oxytocin augmentation, vaginal birth within 24 hours, and induction-to-birth interval.

Main Results:

• Oral misoprostol was associated with lower rates of cesarean birth and reduced oxytocin augmentation.
• Vaginal dinoprostone was associated with higher rates of vaginal birth within 24 hours and a shorter induction-to-birth interval.
• No significant differences were found in uterine hyperstimulation, 5-minute Apgar scores, or NICU admissions.

Conclusions:

• Oral misoprostol appears to reduce cesarean births and the need for oxytocin augmentation.
• Vaginal dinoprostone may increase the likelihood of vaginal birth within 24 hours and shorten the induction-to-birth interval.
• Maternal and neonatal safety outcomes are comparable, suggesting oral misoprostol as a viable option in selected cases.