Evaluating Labor Induction Methods: Insights from the Latest Cochrane Review

Low-dose vaginal misoprostol remained the most effective method for achieving vaginal delivery within 24 hours in a pooled analysis of induction trials, a finding that informs choices about time-to-delivery and strategies to reduce cesarean delivery for fetal concern. It also highlights the need to weigh short-term effectiveness against differing safety profiles when selecting an induction method.

The pooled analysis combined data from more than 100 randomized trials comparing 13 induction methods and prioritized vaginal delivery within 24 hours, cesarean for fetal concern, and perinatal death as primary endpoints. Heterogeneity in protocols and patient populations limits certainty for some pairwise comparisons.

Available evidence indicates mechanical methods such as balloon catheters are linked to lower rates of uterine hyperstimulation than some pharmacologic options. Pharmacologic agents (misoprostol, oxytocin) generally offer more effective cervical ripening and faster progress but carry higher risk of uterine tachysystole—outcomes that should be interpreted in the context of trial variability.

In practice, misoprostol serves as an effective benchmark for term inductions: no method in the network exceeded its 24-hour vaginal delivery rates. Thus, method choice at term should balance modest differences in time-to-delivery against individual safety needs and local monitoring capacity. When choosing between misoprostol and oxytocin, note misoprostol's higher hyperstimulation risk, which requires closer fetal surveillance and ready neonatal support. Evidence for induction after prior cesarean remains limited; current data favor mechanical approaches or cautious pharmacologic use with rigorous surveillance, and individualized selection is advised given these gaps.