Misoprostol Versus Oxytocin for Labor Induction in Term Prelabor Rupture of Membranes: A Systematic Review of Their Efficacy and Safety.

Abstract

Prelabor rupture of membranes (PROM) at term is a common obstetric event requiring safe and effective labor induction. While oxytocin has traditionally been used for this purpose, misoprostol offers a potentially advantageous alternative due to its multiple routes of administration. This systematic review aims to compare the efficacy and safety of misoprostol versus oxytocin for labor induction in women with term PROM. A systematic search was conducted across PubMed, Embase, Scopus, and ClinicalTrials.gov for studies published in the last five years. Randomized controlled trials (RCTs) and comparative studies comparing misoprostol and oxytocin for labor induction in term PROM were included. Study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2 (RoB 2) tool were performed by two independent reviewers. A narrative synthesis was conducted due to clinical heterogeneity. Six studies were included. Efficacy-related findings were heterogeneous. Two studies found that oxytocin significantly reduced the time to delivery, particularly in nulliparous women with an unfavorable cervix. Conversely, two studies reported that sublingual misoprostol resulted in a shorter induction time and a significantly lower cesarean section rate. Other studies found no significant differences in vaginal delivery rates within 24 hours. Critically, both agents demonstrated comparable and reassuring safety profiles, with no significant differences in major maternal morbidities or adverse neonatal outcomes. Both misoprostol and oxytocin are effective and safe for labor induction in term PROM. The optimal choice is context-dependent; oxytocin may be preferable for faster delivery in monitored settings for specific subgroups, while sublingual misoprostol is a highly effective alternative that may reduce cesarean rates and offers logistical benefits. The choice should be individualized based on clinical setting, patient characteristics, and preferences.