CLINICAL QUESTION

Are oral prostaglandins as safe and effective as oxytocin for induction of labor in pregnant patients with rupture of membranes at term but before labor onset (ie, premature rupture of membranes [PROM])?

EVIDENCE-BASED ANSWER

In pregnant patients with PROM, oral prostaglandins (eg, misoprostol) are as effective as intravenous (IV) oxytocin infusion for achieving vaginal delivery within 24 hours of initiation. (Strength of Recommendation [SOR]: A, meta-analyses of randomized controlled trials [RCTs] and subsequent RCTs.) Use of oral misoprostol is associated with similar risks of uterine hyperstimulation, tachysystole, need for cesarean delivery, and meconium-stained amniotic fluid as use of IV oxytocin. (SOR: A, meta-analysis of RCTs.)

EVIDENCE SUMMARY

A 2014 systematic review and meta-analysis broadly assessed use of oral misoprostol for labor induction in the third trimester. A subgroup analysis compared oral misoprostol with oxytocin in pregnant patients with PROM. Patients in this group were predominantly nulliparous with initial Bishop scores of 4.5 to 6.0. Trials were conducted in a variety of predominantly tertiary care settings in multiple countries. Misoprostol regimens varied, with most dosages between 50 and 100 mcg every 4 or 6 hours.¹