FPIN's Help Desk Answers

Labor Induction at Term


Am Fam Physician. 2016 Feb 15;93(4):266-268.

Clinical Question

What is the best way to induce labor in a patient at term?

Evidence-Based Answer

Oral misoprostol (Cytotec), vaginal and intracervical prostaglandins, and mechanical methods are effective for induction of labor at term. (Strength of Recommendation [SOR]: B, based on Cochrane reviews.) The use of intravenous oxytocin (Pitocin) increases the risk of failure to achieve vaginal delivery at 24 hours and the risk of cesarean delivery compared with prostaglandins and mechanical methods of labor induction. (SOR: B, based on systematic reviews.)

A 2014 Cochrane review of 76 randomized controlled trials (RCTs; N = 14,412) compared the effectiveness and safety of oral misoprostol with placebo and other methods of labor induction in the third trimester.1 Oral misoprostol led to fewer cesarean deliveries than vaginal prostaglandin E2 (PGE2; 12 RCTs; N = 3,859; relative risk [RR] = 0.88; 95% confidence interval [CI], 0.78 to 0.99). There was no difference in the proportion of women achieving vaginal delivery within 24 hours with oral misoprostol vs. intravenous oxytocin (six RCTs; N = 789; RR = 0.79; 95% CI, 0.59 to 1.05), and no difference in a subgroup

Address correspondence to Elin Kondrad, MD, at ekondrad@gmail.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


1. Alfirevic Z, Aflaifel N, Weeks A. Oral misoprostol for induction of labor. Cochrane Database Syst Rev. 2014;(6):CD001338.

2. Alfirevic Z, Kelly AJ, Dowswell T. Intravenous oxytocin alone for cervical ripening and induction of labor. Cochrane Database Syst Rev. 2009;(4):CD003246.

3. Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M. Mechanical methods for induction of labor. Cochrane Database Syst Rev. 2012;(3):CD001233.

Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review.

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell, Jr., MD, MSPH, Assistant Medical Editor.


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