Induction of Labor: The Misoprostol Controversy

Alisa B. Goldberg, MD, MPH, Deborah A. Wing, MD


J Midwifery Womens Health. 2003;48(4) 

In This Article

Oral Misoprostol

Although women and their care providers may prefer oral rather than vaginal administration of misoprostol,[28] the evidence to date suggests that at a given dose, the oral route of administration is less effective than the vaginal route for labor induction.[24] Using higher doses of misoprostol orally may increase efficacy; however, this may be associated with high-peak serum levels and a higher incidence of adverse effects, including uterine hyperstimulation with the potential for fetal compromise.[29] In addition, there are less data from randomized controlled trials (13 trials, including approximately 2700 women) to support the use of orally administered misoprostol, rather than vaginally administered, for labor induction at this time.[24]

Other methods of misoprostol administration, including frequent administration (titration) of a low-dose oral misoprostol solution[30] and the buccal[3] and sublingual[32] routes of administration are promising but currently experimental. Alternative routes of administration are associated with different pharmacokinetic profiles and, therefore, appropriate dosing may differ substantially from the currently accepted vaginal regimen.[33]


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