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Meta-Analysis
. 2025 Apr 21;25(1):461.
doi: 10.1186/s12884-025-07592-2.

Efficacy and safety of misoprostol versus oxytocin for labor induction in women with prelabor rupture of membranes: a meta-analysis

Anluzi Che  1 , Si Si  2 , Jing Liu  3
Affiliations
Meta-Analysis

Efficacy and safety of misoprostol versus oxytocin for labor induction in women with prelabor rupture of membranes: a meta-analysis

Anluzi Che et al. BMC Pregnancy Childbirth. .

Abstract

Background: Prelabor rupture of membranes (PROM) complicates 8% of pregnancies, often necessitating labor induction to prevent maternal and neonatal complications. Misoprostol, a cost-effective prostaglandin, has been proposed as an alternative to oxytocin for labor induction in PROM cases, but its efficacy and safety remain debated.

Methods: The PubMed, Web of science, Embase, Google scholar, ClinicalTrials.gov, and Cochrane Library databases were searched on January 25, 2025. Randomized controlled trials (RCTs) comparing misoprostol and oxytocin for labor induction in term PROM were eligible. The primary outcomes were vaginal birth within 24 h and the induction to delivery interval. Secondary outcomes included the duration of second stage of labor, the induction to active labor, cesarean section, postpartum hemorrhage (PPH), and other maternal/neonatal complications.

Results: Data from 20 RCTs involving 2,980 participants were analyzed. Misoprostol significantly reduced the induction-to-delivery interval and the duration of the second stage of labor compared to oxytocin (WMD = -62.82, 95% CI (-110.56, -15.08); WMD = -4.29, 95% CI (-8.05, -0.52), respectively). It also lowered the risk of PPH (OR = 0.63, 95% CI (0.41, 0.98)). However, no significant differences were found in other outcomes between misoprostol and oxytocin.

Conclusions: Misoprostol is a viable alternative to oxytocin for labor induction in PROM, offering shorter labor durations and reduced PPH risk without compromising maternal and neonatal outcomes. Further researches are needed to optimize dosing, administration routes, and assess maternal satisfaction.

Keywords: Efficacy; Labor induction; Meta-analysis; Misoprostol; Oxytocin; PROM; Prelabor rupture of membranes; Safety.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Board (IRB) of the First Hospital of China Medical University (NO. 2025034 on Jan 27, 2025). The study followed the principles of the Declaration of Helsinki. The IRB of the First Hospital of China Medical University waived the need for informed consent because this was a meta-analysis study based on published data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow-chart of study selection
Fig. 2
Fig. 2
Risk of bias summary
Fig. 3
Fig. 3
Risk of bias graph
Fig. 4
Fig. 4
Forest plots (random effect model) of meta-analysis of the difference between misoprostol and oxytocin in the induction to delivery interval. WMD, weighted mean difference
See this image and copyright information in PMC

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