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Evaluating misoprostol and mechanical methods for induction of labour (Scientific Impact Paper No. 68)

This Scientific Impact Paper reviews the use of the drug misoprostol for the induction of labour as well as ‘mechanical’ induction using a balloon catheter. The paper examines the evidence that suggests these methods are both at least as safe and effective as using the standard drug, dinoprostone. The effects of these methods on birth outcomes and number of caesarean births is discussed, along with suitability for outpatient or home induction and the advantages for specific patient groups.

Plain language summary

Increasingly, births around the world are started artificially using medications or other methods. This process is known as induction of labour. As it becomes more common, methods are needed to meet the different clinical needs and birth preferences of women.

Induction of labour typically includes a combination of the medication dinoprostone inserted into the vagina, artificial rupture of membranes (‘releasing the waters’), and synthetic oxytocin (hormone given via a drip).

This paper reviews some of the methods less commonly used for induction in the UK, namely a drug called misoprostol, which can be given orally or vaginally, and ‘mechanical’ methods, where labour is started by stretching the cervix (neck of the womb), most commonly with a soft silicone tube with a balloon near the tip, filled with water.

Low-dose oral misoprostol tablets are now commercially available in the UK. Other methods for labour induction are not reviewed in detail in this paper.

The evidence suggests mechanical induction of labour (using a balloon catheter) and misoprostol are both at least as safe and effective as using the standard drug, dinoprostone.

There is evidence to suggest a balloon catheter may reduce the chance of serious negative outcomes for babies when compared with dinoprostone, and that giving low-dose oral misoprostol results in fewer caesarean births.

Where possible and after informed consent, the method of induction of labour should be personalised to suit the individual woman, her clinical condition, and the setting in which she is giving birth. Local contexts and resources also need to be taken into account.

To date, research into women's perspectives and experiences of induction of labour have been significantly lacking.

COVID disclaimer: This Scientific Impact Paper was developed prior to the emergence of the COVID-19 coronavirus.

Version history: This is the first edition of this paper.

Please note that the Scientific Advisory Committee regularly assesses the need to update. Further information on this review is available on request.

Developer declaration of interests:

Available upon request.