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

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.