Low-dose vaginal misoprostol may outperform dinoprostone Vaginal misoprostol improved induction speed without increasing cesarean birth.
*Systematic review and meta-analysis of randomized trials; Level 1a (OCEBM).

Citation

Andersson G, Greenfield B, Hunt A, et al. Vaginal Misoprostol Compared to Vaginal Dinoprostone for Induction of Labour: A Systematic Review and Meta-Analysis. BJOG. 2026;0:1-12. doi:10.1111/1471-0528.70314

Background

Induction of labor is common, and dinoprostone is often used first. Misoprostol may work faster, but safety concerns include overly frequent contractions and fetal heart rate changes.

Patients

13,644 participants in 44 randomized trials with singleton, head-down, term pregnancies. Exclusions included trials before 2000, non-term or non-singleton pregnancies, and induction after fetal death.

Intervention

Vaginal misoprostol, including 25 microgram and 50 microgram or higher regimens.

Control

Vaginal dinoprostone, using gel, tablet, or pessary preparations; this is a commonly available current treatment.

Outcome

Primary outcome: vaginal birth within 24 hours. Secondary outcomes included time to birth, oxytocin use, cesarean birth, uterine overactivity, and maternal and newborn harms.

Follow-up Period

Birth hospitalization; longer maternal or infant follow-up was not reported.

Results

Outcome Finding with vaginal misoprostol versus dinoprostone
Vaginal birth within 24 hours (primary) More likely: OR 1.48 (95% CI 1.20 to 1.84)
Time from induction to birth Shorter by 230 minutes (95% CI 175 to 286 minutes shorter)
Need for oxytocin Lower: OR 0.51 (95% CI 0.40 to 0.65)
Uterine overactivity with fetal heart rate changes Higher overall: OR 1.56 (95% CI 1.11 to 2.20); not increased with 25 micrograms
OCEBM = Oxford Centre for Evidence-Based Medicine; OR = odds ratio; CI = confidence interval.
Cesarean birth, instrumental birth, serious maternal harms, and newborn harms were NS. The 25 microgram misoprostol subgroup appeared similarly effective with less uterine overactivity. Absolute event rates were not provided, so number needed to treat could not be calculated.

Limitations

Treatment doses and schedules varied widely, creating high inconsistency for key outcomes. Many trials had blinding concerns. Several safety outcomes were rarely reported, limiting certainty about uncommon harms.

Funding

No specific funding; no declared conflicts.

Clinical Application

Consider 25 microgram vaginal misoprostol as an induction option; it may shorten labor and reduce oxytocin without increasing cesarean birth.