Comparison of labor induction with misoprostol vs oxytocin/prostaglandin E(2) in term pregnancy

Objective: To compare the efficacy and safety of intravaginal and oral misoprostol vs. oxytocin/prostaglandin E(2) (PGE(2)) gel for third trimester labor induction. Methods: Two hundred twenty-four pregnant women were randomized to induction of labor either with misoprostol or oxytocin and PGE(2) gel. Patients in the misoprostol group (n = 112) received 100 mu g intravaginal misoprostol followed by 100 mu g p.o. every 2 h. The oxytocin/PGE(2) group consisted of 112 patients who underwent PGE(2) cervical instillation 6 h before continuous oxytocin infusion. The perinatal, intrapartum and neonatal characteristics of both groups were determined. Results: Induction to active phase of labor was successfully achieved in 96 women (85.7%) in the misoprostol group vs. 86 women (76.8%) in the oxytocin/PGE(2) group, but the drug initiation-delivery interval was significantly shorter in the misoprostol group (9.2 +/- 2.4 h) than in the oxytocin/PGE(2) group (15.2 +/- 3.2 h, P < 0.001). The incidence of adverse intrapartum outcomes was similar for both methods. Intravaginal misoprostol 100 mu g followed by a single oral dose of 100 mu g misoprostol safely produced labor and a vaginal delivery in 70% of patients. More than three tablets were required in only 10% of patients. There was a higher prevalence of cesarean section for failed induction in the oxytocin/PGE(2) group than in the misoprostol group (13.4 vs. 6.3%, P < 0.001). The neonatal outcomes of both groups were also similar. Conclusion: Misoprostol is significantly more effective for labor induction than oxytocin/PGE(2) gel. The maternal intrapartum and neonatal outcomes were the same for both induction regimens. From a clinical and perinatal perspective, misoprostol is an acceptable choice for labor induction.