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Meta-Analysis
. 2014 Jun 13;2014(6):CD001338.
doi: 10.1002/14651858.CD001338.pub3.

Oral misoprostol for induction of labour

Zarko Alfirevic  1 , Nasreen Aflaifel, Andrew Weeks
Affiliations
Meta-Analysis

Oral misoprostol for induction of labour

Zarko Alfirevic et al. Cochrane Database Syst Rev. .

Abstract

Background: Misoprostol is an orally active prostaglandin. In most countries misoprostol is not licensed for labour induction, but its use is common because it is cheap and heat stable.

Objectives: To assess the use of oral misoprostol for labour induction in women with a viable fetus.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 January 2014).

Selection criteria: Randomised trials comparing oral misoprostol versus placebo or other methods, given to women with a viable fetus for labour induction.

Data collection and analysis: Two review authors independently assessed trial data, using centrally-designed data sheets.

Main results: Overall there were 76 trials (14,412) women) which were of mixed quality.In nine trials comparing oral misoprostol with placebo (1109 women), women using oral misoprostol were more likely to give birth vaginally within 24 hours (risk ratio (RR) 0.16, 95% confidence interval (CI) 0.05 to 0.49; one trial; 96 women), need less oxytocin (RR 0.42, 95% CI 0.37 to 0.49; seven trials; 933 women) and have a lower caesarean section rate (RR 0.72, 95% CI 0.54 to 0.95; eight trials; 1029 women).In 12 trials comparing oral misoprostol with vaginal dinoprostone (3859 women), women given oral misoprostol were less likely to need a caesarean section (RR 0.88, 95% CI 0.78 to 0.99; 11 trials; 3592 women). There was some evidence that they had slower inductions, but there were no other statistically significant differences.Nine trials (1282 women) compared oral misoprostol with intravenous oxytocin. The caesarean section rate was significantly lower in women who received oral misoprostol (RR 0.77, 95% CI 0.60 to 0.98; nine trials; 1282 women), but they had increased rates of meconium-stained liquor (RR 1.65, 95% CI 1.04 to 2.60; seven trials; 1172 women).Thirty-seven trials (6417 women) compared oral and vaginal misoprostol and found no statistically significant difference in the primary outcomes of serious neonatal morbidity/death or serious maternal morbidity or death. The results for vaginal birth not achieved in 24 hours, uterine hyperstimulation with fetal heart rate (FHR) changes, and caesarean section were highly heterogenous - for uterine hyperstimulation with FHR changes this was related to dosage with lower rates in those with lower doses of oral misoprostol. However, there were fewer babies born with a low Apgar score in the oral group (RR 0.60, 95% CI 0.44 to 0.82; 19 trials; 4009 babies) and a decrease in postpartum haemorrhage (RR 0.57, 95% CI 0.34 to 0.95; 10 trials; 1478 women). However, the oral misoprostol group had an increase in meconium-stained liquor (RR 1.22, 95% CI 1.03 to 1.44; 24 trials; 3634 women).

Authors' conclusions: Oral misoprostol as an induction agent is effective at achieving vaginal birth. It is more effective than placebo, as effective as vaginal misoprostol and results in fewer caesarean sections than vaginal dinoprostone or oxytocin.Where misoprostol remains unlicensed for the induction of labour, many practitioners will prefer to use a licensed product like dinoprostone. If using oral misoprostol, the evidence suggests that the dose should be 20 to 25 mcg in solution. Given that safety is the primary concern, the evidence supports the use of oral regimens over vaginal regimens. This is especially important in situations where the risk of ascending infection is high and the lack of staff means that women cannot be intensely monitored.

PubMed Disclaimer

Conflict of interest statement

Zarko Alfirevic is one of the principal investigators of a trial included in this review. He acted as an adviser and co‐investigator on the Phase III trials to companies involved in the development of misoprostol products for labour induction, but payments were on a one‐off basis with no regular or long‐lasting personal relationships with any organisation. Neither he, nor his immediate family, hold any shares or stocks in any company. Andrew Weeks runs the www.misoprostol.org website as a service to provide accurate information to women about misoprostol use. He is principal investigator for an MRC funded phase 3 study of oral misoprostol for labour induction. Neither he nor his family have financial interests that would gain from an increased use of misoprostol.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 1 Vaginal delivery not achieved in 24 hours.
1.2
1.2. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 2 Uterine hyperstimulation with FHR changes.
1.3
1.3. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 3 Caesarean section.
1.4
1.4. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 4 Serious neonatal morbidity or perinatal death.
1.5
1.5. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 5 Serious maternal morbidity or death.
1.6
1.6. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 6 Epidural analgesia.
1.7
1.7. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 7 Oxytocin augmentation.
1.8
1.8. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 8 Uterine hyperstimulation without FHR changes.
1.11
1.11. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 11 Instrumental vaginal delivery.
1.12
1.12. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 12 Meconium‐stained liquor.
1.13
1.13. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 13 Apgar score < 7 at 5 minutes.
1.14
1.14. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 14 Neonatal intensive care unit admission.
1.15
1.15. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 15 Perinatal death.
1.16
1.16. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 16 Nausea.
1.17
1.17. Analysis
Comparison 1 Oral misoprostol versus placebo/ no treatment (1): all women, Outcome 17 Vomiting.
2.1
2.1. Analysis
Comparison 2 Oral misoprostol versus placebo/ no treatment (1): all women with intact membranes, Outcome 1 Uterine hyperstimulation with FHR changes.
3.1
3.1. Analysis
Comparison 3 Oral misoprostol versus placebo/ no treatment (1): all women with ruptured membranes, Outcome 1 Vaginal delivery not achieved in 24 hours.
3.2
3.2. Analysis
Comparison 3 Oral misoprostol versus placebo/ no treatment (1): all women with ruptured membranes, Outcome 2 Uterine hyperstimulation with FHR changes.
3.3
3.3. Analysis
Comparison 3 Oral misoprostol versus placebo/ no treatment (1): all women with ruptured membranes, Outcome 3 Caesarean section.
3.4
3.4. Analysis
Comparison 3 Oral misoprostol versus placebo/ no treatment (1): all women with ruptured membranes, Outcome 4 Serious neonatal morbidity or perinatal death.
3.5
3.5. Analysis
Comparison 3 Oral misoprostol versus placebo/ no treatment (1): all women with ruptured membranes, Outcome 5 Serious maternal morbidity or death.
4.1
4.1. Analysis
Comparison 4 Oral misoprostol versus placebo/ no treatment (1): all primiparae with ruptured membranes, Outcome 1 Uterine hyperstimulation with FHR changes.
4.2
4.2. Analysis
Comparison 4 Oral misoprostol versus placebo/ no treatment (1): all primiparae with ruptured membranes, Outcome 2 Caesarean section.
4.3
4.3. Analysis
Comparison 4 Oral misoprostol versus placebo/ no treatment (1): all primiparae with ruptured membranes, Outcome 3 Serious maternal morbidity or death.
5.1
5.1. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 1 Vaginal delivery not achieved within 24 hours.
5.2
5.2. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 2 Uterine hyperstimulation with FHR changes.
5.3
5.3. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 3 Caesarean section.
5.4
5.4. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 4 Serious neonatal morbidity or perinatal death.
5.5
5.5. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 5 Serious maternal morbidity or death.
5.6
5.6. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
5.7
5.7. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 7 Oxytocin augmentation.
5.8
5.8. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 8 Uterine hyperstimulation without FHR changes.
5.9
5.9. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 9 Ruptured uterus.
5.10
5.10. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 10 Epidural analgesia.
5.11
5.11. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 11 Instrumental vaginal delivery.
5.12
5.12. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 12 Meconium‐stained liquor.
5.13
5.13. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 13 Apgar score < 7 at 5 minutes.
5.14
5.14. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 14 Neonatal intensive care unit admission.
5.15
5.15. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 15 Neonatal encephalopathy.
5.16
5.16. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 16 Perinatal death.
5.17
5.17. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 17 Maternal side effects (all).
5.18
5.18. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 18 Nausea.
5.19
5.19. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 19 Vomiting.
5.20
5.20. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 20 Diarrhoea.
5.21
5.21. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 21 Shivering.
5.22
5.22. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 22 Postpartum haemorrhage.
5.23
5.23. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 23 Serious maternal complications.
5.24
5.24. Analysis
Comparison 5 Oral misoprostol versus vaginal PG (2): all women, Outcome 24 Hyperpyrexia.
6.1
6.1. Analysis
Comparison 6 Oral misoprostol versus vaginal PG (2): all women with intact membranes, Outcome 1 Vaginal delivery not achieved within 24 hours.
6.2
6.2. Analysis
Comparison 6 Oral misoprostol versus vaginal PG (2): all women with intact membranes, Outcome 2 Uterine hyperstimulation with FHR changes.
6.3
6.3. Analysis
Comparison 6 Oral misoprostol versus vaginal PG (2): all women with intact membranes, Outcome 3 Caesarean section.
6.4
6.4. Analysis
Comparison 6 Oral misoprostol versus vaginal PG (2): all women with intact membranes, Outcome 4 Serious neonatal morbidity or perinatal death.
6.5
6.5. Analysis
Comparison 6 Oral misoprostol versus vaginal PG (2): all women with intact membranes, Outcome 5 Serious maternal morbidity or death.
6.6
6.6. Analysis
Comparison 6 Oral misoprostol versus vaginal PG (2): all women with intact membranes, Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
7.1
7.1. Analysis
Comparison 7 Oral misoprostol versus vaginal PG (2): all women with ruptured membranes, Outcome 1 Vaginal delivery not achieved within 24 hours.
7.2
7.2. Analysis
Comparison 7 Oral misoprostol versus vaginal PG (2): all women with ruptured membranes, Outcome 2 Caesarean section.
8.1
8.1. Analysis
Comparison 8 Oral misoprostol versus vaginal PG (2): all women with unfavourable cervices, Outcome 1 Vaginal delivery not achieved within 24 hours.
9.1
9.1. Analysis
Comparison 9 Oral misoprostol versus vaginal PG (2): all women with favourable cervices, Outcome 1 Vaginal delivery not achieved within 24 hours.
10.1
10.1. Analysis
Comparison 10 Oral misoprostol versus vaginal PG (2): all multiparae, Outcome 1 Vaginal delivery not achieved within 24 hours.
10.2
10.2. Analysis
Comparison 10 Oral misoprostol versus vaginal PG (2): all multiparae, Outcome 2 Uterine hyperstimulation with FHR changes.
10.3
10.3. Analysis
Comparison 10 Oral misoprostol versus vaginal PG (2): all multiparae, Outcome 3 Caesarean section.
11.1
11.1. Analysis
Comparison 11 Oral misoprostol versus vaginal PG (2): all primiparae, Outcome 1 Vaginal delivery not achieved within 24 hours.
11.2
11.2. Analysis
Comparison 11 Oral misoprostol versus vaginal PG (2): all primiparae, Outcome 2 Uterine hyperstimulation with FHR changes.
11.3
11.3. Analysis
Comparison 11 Oral misoprostol versus vaginal PG (2): all primiparae, Outcome 3 Caesarean section.
12.1
12.1. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 1 Vaginal delivery not achieved within 24 hours.
12.2
12.2. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 2 Uterine hyperstimulation with FHR changes.
12.3
12.3. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 3 Caesarean section.
12.4
12.4. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 4 Serious neonatal morbidity or perinatal death.
12.5
12.5. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 5 Serious maternal morbidity or death.
12.6
12.6. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 6 Cervix unfavourable/unchanged after 12‐24 hours.
12.7
12.7. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 7 Oxytocin augmentation.
12.8
12.8. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 8 Uterine hyperstimulation without FHR changes.
12.9
12.9. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 9 Uterine rupture.
12.10
12.10. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 10 Perinatal death.
12.11
12.11. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 11 Instrumental vaginal delivery.
12.12
12.12. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 12 Meconium‐stained liquor.
12.13
12.13. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 13 Apgar score < 7 at 5 minutes.
12.14
12.14. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 14 Neonatal intensive care unit admission.
12.15
12.15. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 15 Neonatal encephalopathy.
12.16
12.16. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 16 Maternal death.
12.17
12.17. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 17 Maternal side effects (all).
12.18
12.18. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 18 Postpartum haemorrhage.
12.19
12.19. Analysis
Comparison 12 Oral misoprostol versus intracervical PG (3): all women, Outcome 19 Women not satisfied.
13.1
13.1. Analysis
Comparison 13 Oral misoprostol versus intracervical PG (3): all women with intact membranes, Outcome 1 Vaginal delivery not achieved within 24 hours.
13.2
13.2. Analysis
Comparison 13 Oral misoprostol versus intracervical PG (3): all women with intact membranes, Outcome 2 Uterine hyperstimulation with FHR changes.
13.3
13.3. Analysis
Comparison 13 Oral misoprostol versus intracervical PG (3): all women with intact membranes, Outcome 3 Caesarean section.
13.4
13.4. Analysis
Comparison 13 Oral misoprostol versus intracervical PG (3): all women with intact membranes, Outcome 4 Serious neonatal morbidity or perinatal death.
13.5
13.5. Analysis
Comparison 13 Oral misoprostol versus intracervical PG (3): all women with intact membranes, Outcome 5 Serious maternal morbidity or death.
14.1
14.1. Analysis
Comparison 14 Oral misoprostol versus intracervical PG (3): all women with ruptured membranes, Outcome 1 Vaginal delivery not achieved in 24 hours.
14.2
14.2. Analysis
Comparison 14 Oral misoprostol versus intracervical PG (3): all women with ruptured membranes, Outcome 2 Caesarean section.
15.1
15.1. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 1 Vaginal delivery not achieved in 24 hours.
15.2
15.2. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 2 Uterine hyperstimulation with FHR changes.
15.3
15.3. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 3 Caesarean section.
15.4
15.4. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 4 Serious neonatal morbidity or perinatal death.
15.5
15.5. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 5 Serious maternal morbidity or death.
15.6
15.6. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 6 Oxytocin augmentation.
15.7
15.7. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 7 Uterine hyperstimulation without FHR changes.
15.8
15.8. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 8 Uterine rupture.
15.9
15.9. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 9 Epidural analgesia.
15.10
15.10. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 10 Instrumental vaginal delivery.
15.11
15.11. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 11 Meconium‐stained liquor.
15.12
15.12. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 12 Apgar score < 7 at 5 minutes.
15.13
15.13. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 13 Neonatal intensive care unit admission.
15.14
15.14. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 14 Neonatal encephalopathy.
15.15
15.15. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 15 Perinatal death.
15.16
15.16. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 16 Nausea.
15.17
15.17. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 17 Vomiting.
15.18
15.18. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 18 Diarrhoea.
15.19
15.19. Analysis
Comparison 15 Oral misoprostol versus oxytocin (4): all women, Outcome 19 Postpartum haemorrhage.
16.1
16.1. Analysis
Comparison 16 Oral misoprostol versus oxytocin (4): all women with ruptured membranes, Outcome 1 Vaginal delivery not achieved in 24 hours.
16.2
16.2. Analysis
Comparison 16 Oral misoprostol versus oxytocin (4): all women with ruptured membranes, Outcome 2 Uterine hyperstimulation with FHR changes.
16.3
16.3. Analysis
Comparison 16 Oral misoprostol versus oxytocin (4): all women with ruptured membranes, Outcome 3 Caesarean section.
16.4
16.4. Analysis
Comparison 16 Oral misoprostol versus oxytocin (4): all women with ruptured membranes, Outcome 4 Serious neonatal morbidity or perinatal death.
16.5
16.5. Analysis
Comparison 16 Oral misoprostol versus oxytocin (4): all women with ruptured membranes, Outcome 5 Serious maternal morbidity or death.
16.6
16.6. Analysis
Comparison 16 Oral misoprostol versus oxytocin (4): all women with ruptured membranes, Outcome 6 Meconium‐stained liquor.
17.1
17.1. Analysis
Comparison 17 Oral misoprostol versus oxytocin (4): all primiparae, Outcome 1 Uterine hyperstimulation with FHR changes.
17.2
17.2. Analysis
Comparison 17 Oral misoprostol versus oxytocin (4): all primiparae, Outcome 2 Caesarean section.
18.1
18.1. Analysis
Comparison 18 Oral misoprostol versus oxytocin (4): all primiparae with ruptured membranes, Outcome 1 Uterine hyperstimulation with FHR changes.
18.2
18.2. Analysis
Comparison 18 Oral misoprostol versus oxytocin (4): all primiparae with ruptured membranes, Outcome 2 Caesarean section.
19.1
19.1. Analysis
Comparison 19 Oral misoprostol versus oxytocin (4): all multiparae, Outcome 1 Caesarean section.
20.1
20.1. Analysis
Comparison 20 Oral versus sublingual misoprostol (5): all women, Outcome 1 Caesarean section.
20.2
20.2. Analysis
Comparison 20 Oral versus sublingual misoprostol (5): all women, Outcome 2 Meconium‐stained liquor.
20.3
20.3. Analysis
Comparison 20 Oral versus sublingual misoprostol (5): all women, Outcome 3 Instrumental delivery.
21.1
21.1. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 1 Vaginal delivery not achieved within 24 hours.
21.2
21.2. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 2 Uterine hyperstimulation with FHR changes.
21.3
21.3. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 3 Caesarean section.
21.4
21.4. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 4 Serious neonatal morbidity or perinatal death.
21.5
21.5. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 5 Serious maternal morbidity or death.
21.6
21.6. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 6 Serious maternal complications.
21.7
21.7. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 7 Oxytocin augmentation.
21.8
21.8. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 8 Uterine hyperstimulation without FHR changes.
21.9
21.9. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 9 Uterine rupture.
21.10
21.10. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 10 Epidural analgesia.
21.11
21.11. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 11 Instrumental vaginal delivery.
21.12
21.12. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 12 Meconium‐stained liquor.
21.13
21.13. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 13 Apgar score < 7 at 5 minutes.
21.14
21.14. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 14 Neonatal intensive care unit admission.
21.15
21.15. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 15 Neonatal encephalopathy.
21.16
21.16. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 16 Perinatal death.
21.17
21.17. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 17 Maternal side effects (all).
21.18
21.18. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 18 Nausea.
21.19
21.19. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 19 Vomiting.
21.20
21.20. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 20 Diarrhoea.
21.21
21.21. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 21 Postpartum haemorrhage.
21.22
21.22. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 22 Woman not satisfied.
21.23
21.23. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 23 Vaginal delivery not achieved within 24 hours (subgroup by quality).
21.24
21.24. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 24 Shivering.
21.25
21.25. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 25 Uterine hyperstimulation with FHR changes (subgroup by quality).
21.26
21.26. Analysis
Comparison 21 Oral versus vaginal misoprostol (6): all women, Outcome 26 Caesarean section (subgroup by quality).
22.1
22.1. Analysis
Comparison 22 Oral versus vaginal misoprostol (6): all women with intact membranes, Outcome 1 Vaginal delivery not achieved within 24 hours.
22.2
22.2. Analysis
Comparison 22 Oral versus vaginal misoprostol (6): all women with intact membranes, Outcome 2 Uterine hyperstimulation with FHR changes.
22.3
22.3. Analysis
Comparison 22 Oral versus vaginal misoprostol (6): all women with intact membranes, Outcome 3 Caesarean section.
22.4
22.4. Analysis
Comparison 22 Oral versus vaginal misoprostol (6): all women with intact membranes, Outcome 4 Serious neonatal morbidity or perinatal death.
22.5
22.5. Analysis
Comparison 22 Oral versus vaginal misoprostol (6): all women with intact membranes, Outcome 5 Serious maternal morbidity or death.
23.1
23.1. Analysis
Comparison 23 Oral versus vaginal misoprostol (6): all primiparae with intact membranes, Outcome 1 Vaginal delivery not achieved within 24 hours.
23.2
23.2. Analysis
Comparison 23 Oral versus vaginal misoprostol (6): all primiparae with intact membranes, Outcome 2 Serious neonatal morbidity or perinatal death.
23.3
23.3. Analysis
Comparison 23 Oral versus vaginal misoprostol (6): all primiparae with intact membranes, Outcome 3 Serious maternal morbidity or death.
24.1
24.1. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 1 Vaginal delivery not achieved within 24 hours.
24.2
24.2. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 2 Uterine hyperstimulation with FHR changes.
24.3
24.3. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 3 Caesarean section.
24.4
24.4. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 4 Serious neonatal morbidity or perinatal death.
24.5
24.5. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 5 Serious maternal morbidity or death.
24.6
24.6. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 6 Oxytocin augmentation.
24.7
24.7. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 7 Uterine hyperstimulation without FHR changes.
24.8
24.8. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 8 Instrumental vaginal delivery.
24.9
24.9. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 9 Apgar score < 7 at 5 minutes.
24.10
24.10. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 10 Nausea.
24.11
24.11. Analysis
Comparison 24 Oral versus vaginal misoprostol (6): all primiparae, Outcome 11 Vomiting.
25.1
25.1. Analysis
Comparison 25 Oral versus vaginal misoprostol (6): all women with ruptured membranes, Outcome 1 Uterine hyperstimulation with FHR changes.
25.2
25.2. Analysis
Comparison 25 Oral versus vaginal misoprostol (6): all women with ruptured membranes, Outcome 2 Caesarean section.
26.1
26.1. Analysis
Comparison 26 Oral versus vaginal misoprostol (6): all primiparae with unfavourable cervix, Outcome 1 Vaginal delivery not achieved within 24 hours.
26.2
26.2. Analysis
Comparison 26 Oral versus vaginal misoprostol (6): all primiparae with unfavourable cervix, Outcome 2 Caesarean section.
26.3
26.3. Analysis
Comparison 26 Oral versus vaginal misoprostol (6): all primiparae with unfavourable cervix, Outcome 3 Serious neonatal morbidity or perinatal death.
26.4
26.4. Analysis
Comparison 26 Oral versus vaginal misoprostol (6): all primiparae with unfavourable cervix, Outcome 4 Serious maternal morbidity or death.
27.1
27.1. Analysis
Comparison 27 Oral versus vaginal misoprostol (6): all multiparae, Outcome 1 Vaginal delivery not achieved within 24 hours.
27.2
27.2. Analysis
Comparison 27 Oral versus vaginal misoprostol (6): all multiparae, Outcome 2 Caesarean section.
27.3
27.3. Analysis
Comparison 27 Oral versus vaginal misoprostol (6): all multiparae, Outcome 3 Serious neonatal morbidity or perinatal death.
27.4
27.4. Analysis
Comparison 27 Oral versus vaginal misoprostol (6): all multiparae, Outcome 4 Serious maternal morbidity or death.
28.1
28.1. Analysis
Comparison 28 Oral versus vaginal misoprostol (6): all multiparae with intact membranes, Outcome 1 Vaginal delivery not achieved within 24 hours.
29.1
29.1. Analysis
Comparison 29 Oral versus vaginal misoprostol (6): all multiparae with unfavourable cervix, Outcome 1 Vaginal delivery not achieved within 24 hours.
29.2
29.2. Analysis
Comparison 29 Oral versus vaginal misoprostol (6): all multiparae with unfavourable cervix, Outcome 2 Caesarean section.
29.3
29.3. Analysis
Comparison 29 Oral versus vaginal misoprostol (6): all multiparae with unfavourable cervix, Outcome 3 Serious neonatal morbidity or perinatal death.
29.4
29.4. Analysis
Comparison 29 Oral versus vaginal misoprostol (6): all multiparae with unfavourable cervix, Outcome 4 Serious maternal morbidity or death.
30.1
30.1. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 1 Vaginal delivery not achieved within 24 hours.
30.2
30.2. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 2 Caesarean section.
30.3
30.3. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 3 Serious neonatal morbidity or perinatal death.
30.4
30.4. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 4 Oxytocin augmentation.
30.5
30.5. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 5 Uterine hyperstimulation without FHR changes.
30.6
30.6. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 6 Uterine rupture.
30.7
30.7. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 7 Apgar score < 7 at 5 minutes.
30.8
30.8. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 8 Neonatal intensive care unit admission.
30.9
30.9. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 9 Nausea.
30.10
30.10. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 10 Vomiting.
30.11
30.11. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 11 Diarrhoea.
30.12
30.12. Analysis
Comparison 30 Hourly 20mcg titrated oral misoprostol versus 4‐hrly oral misoprostol 50mcg (7): all women, Outcome 12 Postpartum haemorrhage.
31.1
31.1. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 1 Uterine hyperstimulation with FHR changes.
31.2
31.2. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 2 Caesaraean section.
31.3
31.3. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 3 Serious maternal morbidity or death.
31.4
31.4. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 4 Oxytocin augmentation.
31.5
31.5. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 5 Uterine hyperstimulation without FHR changes.
31.6
31.6. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 6 Uterine rupture.
31.7
31.7. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 7 Meconium‐stained liquor.
31.8
31.8. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 8 Neonatal intensive care unit admission.
31.9
31.9. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 9 Perinatal death.
31.10
31.10. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 10 Nausea.
31.11
31.11. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 11 Maternal side effects(all).
31.12
31.12. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 12 Nausea.
31.13
31.13. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 13 Vomiting.
31.14
31.14. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 14 Diarrhoea.
31.15
31.15. Analysis
Comparison 31 Oral misoprostol 25 mcg 3‐daily versus 50 mcg 3‐daily (8): all women, Outcome 15 Shivering.
32.1
32.1. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 1 Vaginal delivery not achieved within 24 hours.
32.2
32.2. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 2 Uterine hyperstimulation with FHR changes.
32.3
32.3. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 3 Caesarean section.
32.4
32.4. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 4 Uterine hyperstimulation without FHR changes.
32.5
32.5. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 5 Oxytocin augmentation.
32.6
32.6. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 6 Epidural analgesia.
32.7
32.7. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 7 Instrumental vaginal delivery.
32.8
32.8. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 8 Meconium‐stained liquor.
32.9
32.9. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 9 Apgar score < 7 at 5 minutes.
32.10
32.10. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 10 Neonatal intensive care unit admission.
32.11
32.11. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 11 Nausea.
32.12
32.12. Analysis
Comparison 32 Oral misoprostol 50 mcg versus 100 mcg (9): all women, Outcome 12 Diarrhoea.
33.1
33.1. Analysis
Comparison 33 Oral misoprostol 50 mcg versus 100 mcg (9): all women with intact membranes, Outcome 1 Vaginal delivery not achieved within 24 hours.
33.2
33.2. Analysis
Comparison 33 Oral misoprostol 50 mcg versus 100 mcg (9): all women with intact membranes, Outcome 2 Uterine hyperstimulation with FHR changes.
33.3
33.3. Analysis
Comparison 33 Oral misoprostol 50 mcg versus 100 mcg (9): all women with intact membranes, Outcome 3 Caesarean section.
34.1
34.1. Analysis
Comparison 34 Oral misoprostol 50 mcg versus 100 mcg (9): all women with ruptured membranes, Outcome 1 Uterine hyperstimulation with FHR changes.
34.2
34.2. Analysis
Comparison 34 Oral misoprostol 50 mcg versus 100 mcg (9): all women with ruptured membranes, Outcome 2 Caesarean section.
35.1
35.1. Analysis
Comparison 35 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women, Outcome 1 Uterine hyperstimulation with FHR changes.
35.2
35.2. Analysis
Comparison 35 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women, Outcome 2 Caesarean section.
35.3
35.3. Analysis
Comparison 35 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women, Outcome 3 Oxytocin augmentation.
35.4
35.4. Analysis
Comparison 35 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women, Outcome 4 Uterine hyperstimulation without FHR changes.
35.5
35.5. Analysis
Comparison 35 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women, Outcome 5 Instrumental vaginal delivery.
35.6
35.6. Analysis
Comparison 35 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women, Outcome 6 Meconium‐stained liquor.
35.7
35.7. Analysis
Comparison 35 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women, Outcome 7 Nausea.
35.8
35.8. Analysis
Comparison 35 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women, Outcome 8 Diarrhoea.
36.1
36.1. Analysis
Comparison 36 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women with intact membranes, Outcome 1 Uterine hyperstimulation with FHR changes.
36.2
36.2. Analysis
Comparison 36 Oral misoprostol 3/4‐hourly versus 6‐hourly (10): all women with intact membranes, Outcome 2 Caesarean section.
37.1
37.1. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 1 Vaginal delivery not achieved in 24 hours.
37.2
37.2. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 2 Uterine hyperstimulation with FHR changes.
37.3
37.3. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 3 Caesarean section.
37.4
37.4. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 4 Uterine hyperstimulation without FHR changes.
37.5
37.5. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 5 Instrumental vaginal delivery.
37.6
37.6. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 6 Apgar score < 7 at 5 minutes.
37.7
37.7. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 7 Neonatal intensive care unit admission.
37.8
37.8. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 8 Postpartum haemorrhage.
37.9
37.9. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 9 Diarrhoea.
37.10
37.10. Analysis
Comparison 37 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all women, Outcome 10 Vomiting.
38.1
38.1. Analysis
Comparison 38 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all primiparae, Outcome 1 Vaginal delivery not achieved in 24 hours.
38.2
38.2. Analysis
Comparison 38 Oral miso 3‐hourly vs oral miso x2 then routine oxytocin (11): all primiparae, Outcome 2 Caesarean section.
39.1
39.1. Analysis
Comparison 39 Oral misoprostol versus delayed vaginal postaglandins (12): all women, Outcome 1 Vaginal delivery not achieved in 24 hours.
39.2
39.2. Analysis
Comparison 39 Oral misoprostol versus delayed vaginal postaglandins (12): all women, Outcome 2 Uterine hyperstimulation with FHR changes.
39.3
39.3. Analysis
Comparison 39 Oral misoprostol versus delayed vaginal postaglandins (12): all women, Outcome 3 Caesarean section.
39.4
39.4. Analysis
Comparison 39 Oral misoprostol versus delayed vaginal postaglandins (12): all women, Outcome 4 Oxytocin augmentation.
39.5
39.5. Analysis
Comparison 39 Oral misoprostol versus delayed vaginal postaglandins (12): all women, Outcome 5 Uterine hyperstimulation without FHR changes.
39.6
39.6. Analysis
Comparison 39 Oral misoprostol versus delayed vaginal postaglandins (12): all women, Outcome 6 Instrumental vaginal delivery.
39.7
39.7. Analysis
Comparison 39 Oral misoprostol versus delayed vaginal postaglandins (12): all women, Outcome 7 Apgar score < 7 at 5 minutes.
39.8
39.8. Analysis
Comparison 39 Oral misoprostol versus delayed vaginal postaglandins (12): all women, Outcome 8 Neonatal intensive care unit admission.
39.9
39.9. Analysis
Comparison 39 Oral misoprostol versus delayed vaginal postaglandins (12): all women, Outcome 9 Nausea.
40.1
40.1. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 1 Uterine hyperstimulation with FHR changes.
40.2
40.2. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 2 Caesarean section.
40.3
40.3. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 3 Serious neonatal morbidity/perinatal death.
40.4
40.4. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 4 Oxytocin augmentation.
40.5
40.5. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 5 Uterine hyperstimulation without FHR changes.
40.6
40.6. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 6 Meconium‐stained liquor.
40.7
40.7. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 7 Apgar score < 7 at 5 minutes.
40.8
40.8. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 8 Perinatal death.
40.9
40.9. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 9 Nausea.
40.10
40.10. Analysis
Comparison 40 Oral misoprostol versus dinoprostone vaginal insert, Outcome 10 Vomiting.
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References

References to studies included in this review

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Dyar 2000 (V50) {published data only}
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Elhassan 2007 (V50) {published data only}
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Fisher 2001 (V50) {published data only}
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Hoffman 2001 {published data only}
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Hofmeyr 2001(T) {published and unpublished data}
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How 2001 (V25) {published data only}
    1. How H, Leaseburge L, Khoury J, Siddiqi T, Sibai B. Is there an ideal route of misoprostol administration for cervical ripening and labor induction [abstract]. American Journal of Obstetrics and Gynecology 2001;184(1):S118. - PubMed
    1. How H, Leaseburge L, Khoury J, Siddiqi T, Spinnato J, Sibai B. A comparison of various routes and dosages of misoprostol for cervical ripening and the induction of labor. American Journal of Obstetrics and Gynecology 2001;185:911‐5. - PubMed
Javaid 2008 {published data only}
    1. Javaid MK, Hassan S, Tahira T. Management pre labour rupture of the membranes at term; induction of labor compared with expectant. Professional Medical Journal 2008;15(2):216‐9.
Jindal 2011 (V50) {published data only}
    1. Jindal P, Avasthi K, Kaur M. A comparison of vaginal vs. oral misoprostol for induction of labor‐double blind randomized trial. Journal of Obstetrics and Gynecology of India 2011;61(5):538‐42. - PMC - PubMed
Khazardoost 2011 (V25) {published data only}
    1. Khazardoost S, Hakimi P, Noorzadeh M, Shafaat M. Misoprostol for cervical ripening: a clinical trial in 60 pregnant women. Tehran University Medical Journal 2011;68(10):595‐9.
Kipikasa 2005 {published data only}
    1. Kipikasa JH, Adair CD, Williamson J, Breen JM, Medford LK, Sanchez‐Ramos L. Use of misoprostol on an outpatient basis for postdate pregnancy. International Journal of Gynecology & Obstetrics 2005;88:108‐11. - PubMed
Kwon 2001 (V50) {published data only}
    1. Kwon J, Davies G, MacKenzie V. A comparison of oral and vaginal misoprostol for induction of labour at term: a randomised trial. BJOG: an international journal of obstetrics and gynaecology 2001;108:23‐6. - PubMed
    1. Kwon JS, Mackenzie VP, Davies GAL. A comparison of oral and vaginal misoprostol for induction of labour. American Journal of Obstetrics and Gynecology 1999;180(1 Pt 2):S128. - PubMed
Langenegger 2005 {published data only}
    1. Langenegger EJ, Odendaal HJ, Grove D. Oral misoprostol versus intracervical dinoprostone for induction of labour. International Journal of Gynecology & Obstetrics 2005;88:242‐8. - PubMed
le Roux 2002 (V50) {published data only}
    1. Roux P, Olarogun J, Penny J, Anthony J. Oral and vaginal misoprostol compared with dinoprostone for induction of labor: a randomized controlled trial. Obstetrics & Gynecology 2002;99(2):201‐5. - PubMed
Levy 2007 {published data only}
    1. Levy R, Vaisbuch E, Furman B, Brown D, Volach V, Hagay ZJ. Induction of labor with oral misoprostol for premature rupture of membranes at term in women with unfavorable cervix: a randomized, double‐blind, placebo‐controlled trial. Journal of Perinatal Medicine 2007;35:126‐9. - PubMed
    1. Levy R, Vaisbuch E, Furman B, Doitch H, Oron S, Hagay Z. Prospective randomized clinical trial of immediate induction of labor with oral misoprostol for prelabor rupture of the membranes in women with unfavorable cervix at term. American Journal of Obstetrics and Gynecology 2005;193(6 Suppl):S44.
Lo 2003 {published data only}
    1. Lo J, Alexander J, McIntire D, Leveno K. Efficacy of oral misoprostol in nulliparous women with premature rupture of membranes. American Journal of Obstetrics and Gynecology 2001;185(6 Suppl):S204.
    1. Lo J, Alexander J, McIntire D, Leveno K. Randomized trial of oral misoprostol in nulliparous women with premature rupture of membranes at term. American Journal of Obstetrics and Gynecology 2001;185(6 Suppl):S204.
    1. Lo JY, Alexander JM, McIntire DD, Leveno KJ. Ruptured membranes at term: randomized, double‐blind trial of oral misoprostol for labor induction. Obstetrics & Gynecology 2003;101(4):685‐9. - PubMed
Lyons 2001 {published data only}
    1. Lyons C, Rumney P, Huang W, Morrison E, Thomas S, Nageotte M, et al. Outpatient cervical ripening with oral misoprostol post‐term: induction rates decreased. American Journal of Obstetrics and Gynecology 2001;184(1):S116.
Majoko 2002 (V50) {published data only}
    1. Majoko F, Zwizwai M, Nystrom L, Lindmark G. Vaginal misoprostol for induction of labour: a more effective agent than prostaglandin f2 alpha gel and prostaglandin e2 pessary. Central African Journal of Medicine 2002;48(11‐12):123‐8. - PubMed
Mehrotra 2010 (V50) {published data only}
    1. Mehrotra S, Singh U, Gupta HP. A prospective double blind study using oral versus vaginal misoprostol for labour induction. Journal of Obstetrics & Gynaecology 2010;30(5):461‐4. - PubMed
Moodley 2003 {published data only}
    1. Moodley J, Venkatachalam S, Songca P. Misoprostol for cervical ripening at and near term ‐ a comparative study. South African Journal of Obstetrics and Gynaecology 2003;9(2):34‐7. - PubMed
    1. Moodley J, Venkatachalam S, Songca P. Misoprostol for cervical ripening at and near term‐‐a comparative study. South African Medical Journal 2003;93:371‐4. - PubMed
Mozurkewich 2003 {published data only}
    1. Mozurkewich E, Horrocks J, Daley S, Oeyen P, Sarvis A, Halvorson M, et al. The misoprostol study: a randomized controlled trial of misoprostol for premature rupture of membranes at term. American Journal of Obstetrics and Gynecology 2002;187(6 Pt 2):S168. - PubMed
    1. Mozurkewich E, Horrocks J, Daley S, Oeyen P, Halvorson M, Johnson M, et al. The MisoPROM study: a multicenter randomized comparison of oral misoprostol and oxytocin for premature rupture of membranes at term. American Journal of Obstetrics and Gynecology 2003;189:1026‐30. - PubMed
Nagpal 2009 {published data only}
    1. Nagpal MB, Raghunandan C, Saili A. Oral misoprostol versus intracervical prostaglandin E2 gel for active management of premature rupture of membranes at term. International Journal of Gynecology & Obstetrics 2009;106(1):23‐6. - PubMed
Ngai 1996 {published data only}
    1. Ngai CSW, To WWK, Lao T, Ho PC. Cervical priming with oral misoprostol in prelabour rupture of membranes at term. 27th British Congress of Obstetrics and Gynaecology;1995 July 4‐7, Dublin, Ireland. 1995:A479.
    1. Ngai SW, To WK, Lao T, Ho PC. Cervical priming with oral misoprostol in pre‐labor rupture of membranes at term. Obstetrics & Gynecology 1996;87:923‐6. - PubMed
Ngai 2000 {published data only}
    1. Jackson N, Paterson‐Brown S. Labour characteristics and uterine activity: misoprostol compared with oxytocin in women at term with prelabour rupture of the membranes [letter]. BJOG: an international journal of obstetrics and gynaecology 2000;107(9):1181‐2. - PubMed
    1. Ngai SW, Chan YM, Lam SW, Lao T. Prospective randomised study to compare misoprostol and oxytocin for labour induction in prelabour rupture of membranes in term pregnancy. British Journal of Obstetrics and Gynaecology 1998;105 Suppl 17:82.
    1. Ngai SW, Chan YM, Lam SW, Lao TT. Labour characteristics and uterine activity: misoprostol compared with oxytocin in women at term with prelabour rupture of membranes. British Journal of Obstetrics and Gynecology 2000;107(2):222‐7. - PubMed
Nigam 2004 {published data only}
    1. Nigam A, Singh VK, Dubay P, Pandey K, Bhagioliwal A, Prakash A. Misoprostol vs. oxytocin for induction of labor at term. International Journal of Gynecology & Obstetrics 2004;86:398‐400. - PubMed
Nopdonrattkaoon 2003 (V50) {published data only}
    1. Nopdonrattakoon L. A comparison between intravaginal and oral misoprostol for labor induction: a randomized controlled trial. Journal of Obstetrics and Gynaecology Research 2003;29(2):87‐91. - PubMed
Pais'wong 2008 (V25) {published data only}
    1. Paisarntantiwong R, Getgan M. A comparison between single dose of 50 microg oral misoprostol and 25 microg vaginal misoprostol for labor induction. Journal of the Medical Association of Thailand 2005;88(Suppl 2):S56‐S62. - PubMed
Patil 2005 {published data only}
    1. Patil PK, Swamy MK, Rao Radhika K. Oral misoprostol vs intra‐cervical dinoprostone for cervical ripening and labour induction. Journal of Obstetrics and Gynaecology of India 2005;55(2):128‐31.
Paungmora 2004 (V50) {published data only}
    1. Paungmora N, Herabutaya Y, O‐Prasertsawat P. A comparison of oral and vaginal misoprostol for induction of labour at term: a randomised controlled trial. Thai Journal of Obstetrics and Gynaecology 2003;15(4):272. - PubMed
    1. Paungmora N, Herabutya Y, O‐Prasertsawat P, Punyavachira P. Comparison of oral and vaginal misoprostol for induction of labor at term: a randomized controlled trial. Journal of Obstetrics & Gynaecology Research 2004;30(5):358‐62. - PubMed
Pongsatha 2001 {published data only}
    1. Pongsatha S, Tongsong T, Somsak T. A comparison between 50 mcg oral misoprostol every 4 hours and 6 hours for labor induction: a prospective randomized controlled trial. Journal of the Medical Association of Thailand 2001;84(7):989‐94. - PubMed
    1. Somsak T, Pongsatha S. A comparison between oral misoprostol 50 micrograms every 4 hours and every 6 hours for labor induction. Thai Journal of Obstetrics and Gynaecology 2000;12(4):334.
Pongsatha 2002 {published data only}
    1. Pongsatha S, Sirisukkasem S, Tongsong T. A comparison of 100ug oral misoprostol every 3 hours and 6 hours for labor induction: a randomized controlled trial. Journal of Obstetrics and Gynaecology Research 2002;28(6):308‐12. - PubMed
Pongsatha 2005 (V50) {published data only}
    1. Pongsatha S, Vijittrawiwat A, Tongsong T. A comparison of labor induction by oral and vaginal misoprostol. International Journal of Gynecology & Obstetrics 2005;88:140‐1. - PubMed
Puga 2001 (V50) {published data only}
    1. Puga O, Nien J, Gomez R, Medina L, Carstens M, Gonzalez R, et al. Premature rupture of membranes after 35 weeks: a randomized clinical trial of induction of labor with oral versus vaginal administration of misoprostol. American Journal of Obstetrics and Gynecology 2001;184(1):S85.
Rahman 2013 (V25) {published data only}
    1. Rahman H. Comparative evaluation of 50ug oral misoprostol and 25ug intra‐vaginal misoprostol for induction of labour at term. 54th All India Congress of Obstetrics and Gynaecology; 2011 January 5‐9; Hyderabad, Andhra Pradesh, India. 2011:316.
    1. Rahman H, Pradhan A, Kharka L, Renjhen P, Kar S, Dutta S. Comparative evaluation of 50 microgram oral misoprostol and 25 microgram intravaginal misoprostol for induction of labour at term: a randomized trial. Journal of Obstetrics and Gynaecology Canada : JOGC 2013;35(5):408‐16. - PubMed
Rath 2007 {published data only}
    1. Rath DM, Manas K. Induction of labor with oral misoprostol in women with prelabor rupture of membranes at term. Journal of Obstetrics and Gynecology of India 2007;57(6):505‐8.
Rizvi 2007 (V25) {published data only}
    1. Rizvi S, Umber F, Yusuf AW. Labour induction at term; oral versus intravaginal misoprostol. Annals of King Edward Medical College 2007;13(1):119‐21.
Rouzi 2014 {published data only}
    1. Rouzi AA. Randomized clinical trial between titrated oral dose of misoprostol and Propess for induction of labor. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=1261... (accessed 22 January 2013) 2011.
    1. Rouzi AA, Alsibiani S, Mansouri N, Alsinani N, Darhouse K. Randomized clinical trial between hourly titrated oral misoprostol and vaginal dinoprostone for induction of labor. American Journal of Obstetrics and Gynecology 2014;210(1):56.e1‐6. - PubMed
Schneider 2004 (V25) {published data only}
    1. Schneider M, Ramsey R, Kao L, Bennett KA. Misoprostol is effective for induction of labor in high risk pregnant women: a randomized controlled trial. American Journal of Obstetrics and Gynecology 2004;191(6 Suppl 1):S73.
Sheela 2007 (V25) {published data only}
    1. Sheela CN, Mhaskar A, George S. Comparison of vaginal misoprostol and oral misoprostol with intracervical dinoprostone gel for labor induction at term. Journal of Obstetrics and Gynaecology of India 2007;57(4):327‐30.
Sheikher 2009 (V25) {published data only}
    1. Sheikher C, Suri N, Kholi U. Comparative evaluation of oral misoprostol, vaginal misoprostol and intracervical Foley's catheter for induction of labour at term. JK Science 2009;11(2):75‐7.
Shetty 2001 (V50) {published data only}
    1. Shetty A, Danielian P, Templeton A. A comparison of oral and vaginal misoprostol in the induction of labour at term: a random allocation trial. Journal of Obstetrics and Gynaecology 2000;20(Suppl 1):S19. - PubMed
    1. Shetty A, Danielian P, Templeton A. A comparison of oral and vaginal misoprostol tablets in induction of labour at term. BJOG: an international journal of obstetrics and gynaecology 2001;108:238‐43. - PubMed
    1. Shetty A, Danielian P, Templeton A. A comparison of oral and vaginal tablets in the induction of labor at term. XVI FIGO World Congress of Obstetrics & Gynecology. Book 4; 2000 Sept 3‐8; Washington DC, USA. 2000:28‐9.
    1. Shetty A, Danielian P, Templeton A. Oral versus vaginal misoprostol in the induction of labour at term: a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2000;107:813.
Shetty 2002 {published data only}
    1. Shetty A, Martin R, Danielian P, Templeton A. A comparison of two dosage regimens of oral misoprostol for labor induction at term. Acta Obstetricia et Gynecologica Scandinavica 2002;81:337‐42. - PubMed
    1. Shetty A, Martin R, Danielian P, Templeton A. A comparison of two dose regimens of oral misoprostol in the induction of labour at term: a random allocation controlled trial [abstract]. Journal of Obstetrics & Gynaecology 2001;21(1):91.
Shetty 2002a {published data only}
    1. Shetty A, Stewart K, Stewart G, Rice P, Danielian P, Templeton A. Active management of term prelabour rupture of membranes with oral misoprostol. BJOG: an international journal of obstetrics and gynaecology 2002;109:1354‐8. - PubMed
Shetty 2003 (V25) {published data only}
    1. Livingstone I, Acharya S, Shetty A, Rice P, Danielian P, Templeton A. 100ug of oral misoprostol versus 25ug of vaginal misoprostol in term labour induction ‐ a randomised comparison. Journal of Obstetrics and Gynaecology 2004;24(1):106. - PubMed
    1. Shetty A, Livingstone I, Acharya S, Rice P, Danielian P, Templeton A. Oral misoprostol (100ug) versus vaginal misoprostol (25ug) in term labor induction: a randomized comparison. Acta Obstetricia et Gynecologica Scandinavica 2003;82(12):1103‐6. - PubMed
Shetty 2004 {published data only}
    1. Shetty A, Livingstone I, Acharya S, Danielian P, Rice P, Templeton A. A randomised comparison of oral misoprostol and vaginal prostaglandin E2 tablets in labour induction at term. BJOG: an international journal of obstetrics and gynaecology 2003;110:963. - PubMed
    1. Shetty A, Livingstone I, Acharya S, Danielian P, Templeton A, Rice P. A randomised comparison of oral misoprostol and vaginal prostaglandin E2 tablets in labour induction at term. BJOG: an international journal of obstetrics and gynaecology 2004;111:436‐40. - PubMed
Sitthiwattanawong 1999 {published data only}
    1. Sitthiwattanawong W. A comparison between oral and intravaginal administration of 50 microgram misoprostol for cervical ripening and induction of labor. Thai Journal of Obstetrics and Gynaecology 2000;12(4):352.
    1. Sitthiwattanawong W, Pongsatha S. Oral misoprostol for cervical ripening and labour induction: a randomized controlled trial. Thai Journal of Obstetrics and Gynaecology 1999;11(2):87‐92.
Souza 2013(V25)(T) {published data only}
    1. Rolland Souza A. [Titrated oral suspension compared with vaginal misoprostol for labor induction: a randomized controlled trial] [Misoprostol em solução oral titulada escalonada versus via vaginal para indução do trabalho de parto: ensaio clínico randomizado]. Revista Brazileira de Ginecologia e Obstetricia 2011;33(9):270.
    1. Rolland de Souza A. Oral misoprostol titrated solution versus vaginal misoprostol for induction of labour: randomized controlled trial. http://clinicaltrials.gov/ct2/show/record/NCT00992524 (accessed 22 January 2013) 2011.
    1. Souza AS, Feitosa FE, Costa AA, Pereira AP, Carvalho AS, Paixao RM, et al. Titrated oral misoprostol solution versus vaginal misoprostol for labor induction. International Journal of Gynecology and Obstetrics 2013;123(3):207‐12. - PubMed
Sultana 2006 (V100) {published data only}
    1. Sultana N, Rouf S, Rashid M. Oral versus vaginal misoprostol for induction of labour. Journal of Bangladesh College of Physicians and Surgeons 2006;24(2):44‐9.
Tessier 1997 {published data only}
    1. * Tessier F, Danserau J. Oral misoprostol versus vaginal dinoprostone for labor induction: a double‐blind randomized controlled trial. Personal communication 1997.
    1. Tessier F, Dansereau J. A double‐blind randomized controlled trial comparing oral misoprostol to vaginal prostaglandin E2 gel for the induction of labour at or near term. American Journal of Obstetrics and Gynecology 1997;176(1):S111.
Thaisomboon 2012 (T) {published data only}
    1. Thaisomboon A, Russameecharoen K, Wanitpongpan P, Phattanachindakun B, Changnoi A. Comparison of the efficacy and safety of titrated oral misoprostol and a conventional oral regimen for cervical ripening and labor induction. International Journal of Gynecology and Obstetrics 2012;116(1):13‐6. - PubMed
Toppozada 1997 (V100 {published data only}
    1. Toppozada MK, Anwar MYM, Hassan HA, El‐Gazaerly WS. Oral or vaginal misoprostol for induction of labour. International Journal of Gynecology & Obstetrics 1997;56:135‐9. - PubMed
Uludag 2005 (V50) {published data only}
    1. Uludag S, Saricali FS, Madazli R, Cepni I. A comparison of oral and vaginal misoprostol for induction of labour. European Journal of Obstetrics & Gynecology and Reproductive Biology 2005;122:57‐60. - PubMed
Wing 1999 (V25) {published data only}
    1. Wing D, Ham D, Paul RH. A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labor induction. American Journal of Obstetrics and Gynecology 1999;180(5):1155‐60. - PubMed
    1. Wing DA, Ham D, Paul RH. A comparison of orally administered misoprostol to vaginally administered misoprostol for cervical ripening and labor induction. American Journal of Obstetrics and Gynecology 1999;180(1 Pt 2):S127. - PubMed
Wing 2000 (V25) {published data only}
    1. Wing DA, Park MR, Paul RH. A randomised comparison of oral and intravaginal misoprostol for labor induction. Obstetrics & Gynecology 2000;95(6 Pt 1):905‐8. - PubMed
Wing 2004 {published data only}
    1. Wing DA, Fassett MJ, Guberman C, Tran S, Parrish A, Guinn D. A comparison of orally administered misoprostol to intravenous oxytocin for labor induction in women with favorable cervix examinations. American Journal of Obstetrics and Gynecology 2004;190:1689‐96. - PubMed

References to studies excluded from this review

Abbassi 2008 {published data only}
    1. Abbassi RM, Sirichand P, Rizvi S. Safety and efficacy of oral versus vaginal misoprostol use for induction of labour at term. Journal of the College of Physicians and Surgeons Pakistan 2008;18(10):625‐9. - PubMed
Ascher‐Walsh 2000 {published data only}
    1. Ascher‐Walsh C, Burke B, Baxi L. Outpatient management of prolonged pregnancy with misoprostol: a randomised, double‐blind, placebo‐controlled study, prelim.data. American Journal of Obstetrics and Gynecology 2000;182(1 Pt 2):S520.
Ayaz 2008 {published data only}
    1. Ayaz A, Saeed S, Farooq MU, Ahmad F, Bahoo LA, Ahmad I. Pre‐labor rupture of membranes at term in patients with an unfavorable cervix: active versus conservative management. Taiwanese Journal of Obstetrics & Gynecology 2008;47(2):192‐6. - PubMed
Bozhinova 2007 {published data only}
    1. Bozhinova S. Is it already time to legalize the usage of cytotec (misoprostol) in the obstetrics' practice?. Akusherstvo i Ginekologiia 2007;46(9):56‐61. - PubMed
Bricker 2008 {published data only}
    1. Bricker L, Peden H, Alfirevic Z. The PROMMIS trial: a multicentre randomised trial to evaluate a low dose misoprostol regimen for induction of labour in the presence of prelabour rupture of the amniotic membranes [abstract]. Journal of Obstetrics and Gynaecology 2007;27(Suppl 1):S22‐3.
    1. Bricker L, Peden H, Tomlinson AJ, Al‐Hussaini TK, Idama T, Candelier C, et al. Titrated low‐dose vaginal and/or oral misoprostol to induce labour for prelabour membrane rupture: a randomised trial. BJOG: an international journal of obstetrics and gynaecology 2008;115(12):1503‐11. - PubMed
Delaney 2001 {published data only}
    1. Delaney T, Crane J, Hutchens D, Fanning C, Young D. Oral misoprostol labor induction in patients with a favorable cervix. American Journal of Obstetrics and Gynecology 2001;185(6 Suppl):S202.
Hassan 2005 {published data only}
    1. Hassan AA. A comparison of oral misoprostol tablets and vaginal prostaglandin E2 pessary in induction of labour at term. Journal of the College of Physicians & Surgeons Pakistan (JCPSP) 2005;15(5):284‐7. - PubMed
Ho 2010 {published data only}
    1. Ho M, Cheng SY, Li TC. Titrated oral misoprostol solution compared with intravenous oxytocin for labor augmentation: a randomized controlled trial. Obstetrics & Gynecology 2010;116(3):612‐8. - PubMed
Kadanali 1996 {published data only}
    1. Kadanali S, Kucukozkan T, Zor N, Kumptepe Y. Comparison of labor induction with misoprostol versus oxytocin/prostaglandin E2 in term pregnancy. International Journal of Gynecology & Obstetrics 1996;55:99‐104. - PubMed
Neto 1988 {published data only}
    1. Neto CM, Delbin AL, Do Val Junior R. Tocographic pattern caused by misoprostol [Padrao tocografico desencadeado pelo misoprostol]. Revista Paulista de Medicina 1988;106(4):205‐8. - PubMed
Rasheed 2007 (V50) {published data only}
    1. Rasheed R, Alam AA, Younus S, Raza F. Oral versus vaginal misoprostol for labour induction. JPMA ‐ Journal of the Pakistan Medical Association 2007;57(8):404‐7. - PubMed
Robinson 2011 {published data only}
    1. Robinson D. Efficacy and safety of titrated oral misoprostol solution for labor induction at term. http://clinicaltrials.gov/ct2/show/record/NCT01070472 (accessed 22 January 2013) 2011.
Thigpen 2004 {published data only}
    1. Thigpen B, Bofill J, Bufkin L, Woodring T, Moore L, Morrison J. A randomized controlled trial comparing vaginal misoprostol to cervical foley plus oral misoprostol for cervical ripening and labor induction [abstract]. American Journal of Obstetrics and Gynecology 2004;191(6 Suppl 1):S18.
Windrim 1997 {published data only}
    1. Windrim R, Bennett K, Mundle W, Young DC. Oral administration of misoprostol for labor induction: a randomized controlled trial. Obstetrics & Gynecology 1997;89:392‐7. - PubMed
Zvandasara 2008 {published data only}
    1. Zvandasara P, Saungweme G, Mlambo J, Chidembo W, Madzivanzira N, Mwanjira C. Induction of labour with titrated oral misoprostol suspension. A comparative study with vaginal misoprostol. Central African Journal of Medicine 2008;54(9‐12):43‐9. - PubMed

References to studies awaiting assessment

Atkinson 2000 {published data only}
    1. Atkinson MW, Van Kessel, Benedetti T. The use of low dose oral misoprostol to induce labour in the third trimester. American Journal of Obstetrics and Gynecology 2000;182(1 Pt 2):S129.
Bonebrake 2001 {published data only}
    1. Bonebrake R, Haag T, Fleming A, Temp M, Haynatzki G. Vaginal misoprostol is more effective with fewer side effects than oral misoprostol for cervical ripening and induction of labor [abstract]. American Journal of Obstetrics and Gynecology 2001;185(6 Suppl):S204.
Butler 2004 {published data only}
    1. Butler B, Crane J, Delaney T. Induction of labour with misoprostol in women at term with an unfavorable cervix: a randomized comparison of oral and vaginal administration. American Journal of Obstetrics and Gynecology 2004;191(6 Suppl 1):S190.
Getgan 2003 {published data only}
    1. Getgan M, Paisarntantiwong R, Sripramote M. A randomized comparison between 50 micrograms orally and misoprostol 25 micrograms vaginally for cervical ripening and induction of labor. Thai Journal of Obstetrics and Gynaecology 2003;15(4):276.
Goedken 2000 {published data only}
    1. Goedken J, Poehlmann S, Paul M. A blinded randomized controlled trial of misoprostol, dinoprostone, and oxytocin for labor induction. Obstetrics & Gynecology 2000;95(4 Suppl):73S.
Madhavi 2011 {published data only}
    1. Madhavi N, Jahan A. Prospective randomised comparative study of labour with misoprostol vs oxytocin in pre labour rupture of membranes. 54th All India Congress of Obstetrics and Gynaecology; 2011 January 5‐9; Hyderabad, Andhra Pradesh, India. 2011:106.
Niroomanesh 2011 {published data only}
    1. Niroomanesh S, Dadashaliha M, Akrami M. Titrated oral misoprostol solution compared with oxytocin for induction of labor in women with unfavorable cervix. Tehran University Medical Journal 2011;69(7):413‐9.
Pearson 2002 {published data only}
    1. Pearson M, Hollier L, Shah A, Yeomans E. A randomized comparison of oral misoprostol versus intravenous oxytocin for induction of labor with term premature rupture of membranes. American Journal of Obstetrics and Gynecology 2002;187(6 Pt 2):S174.
Saldivar 2001 {published data only}
    1. Saldivar D, Triana H, Soria A, Guzman A, Cabero L, Farran I, et al. Oral misoprostol versus intracervical dinoprostone for induction of labour in women with an unfavourable cervix [Misoprostol oral vs dinoprostona intracervical en la induccion del trabajo en pacientes con cervix desfavorable]. Journal of Perinatal Medicine 2001;29 Suppl 1(Pt 1):293.
Tuipae 1999 {published data only}
    1. Tuipae S, Khooarmornpattana S. Effectiveness of oral misoprostol for cervical priming in term pre‐labor rupture of membranes (PROM). Thai Journal of Obstetrics and Gynaecology 1999;11(4):276.
Vijitrawiwat 2003 {published data only}
    1. Vijitrawiwat A, Pongsatha S. A comparison between oral misoprostol 100 micrograms every 3 hours and vaginal misoprostol 50 micrograms every 4 hours for labor induction. Thai Journal of Obstetrics and Gynaecology 2003;15(4):285.
Yazdani 2012 {published data only}
    1. Yazdani SH, Bouzari Z, Farahi S, Tabary AM. Oral misoprostol with oxytocin versus oxytocin alone for labor induction in pre‐labor rupture of membranes (PROM) at term pregnancy. Journal of Babol University of Medical Sciences 2012;14(3):7‐12.
Young 2001 {published data only}
    1. Young D, Delaney T, Armson T, Fanning C. Lower dose vaginal and oral misoprostol in labor induction ‐ rct. American Journal of Obstetrics and Gynecology 2001;185(6 Suppl):S203.

References to ongoing studies

DebBarma 2013 {published data only}
    1. DebBarma AM. A comparative study of misoprostol oral versus vaginal route for induction of labour. http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=4251 (accessed 22 January 2013).
Gherman 2002 {published data only}
    1. Gherman R. A randomized double‐blind comparison of oral misoprostol dosing regimens for cervical ripening. Obstetrics & Gynecology 2002;99(4 Suppl):47S.
Pranuthi 2011 {published data only}
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References to other published versions of this review

Alfirevic 2001
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Alfirevic 2006
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