Oral misoprostol ( <scp>PGE1</scp> ) <i>vs</i> vaginal dinoprostone ( <scp>PGE2</scp> ) for labor induction: individual participant data meta‐analysis of randomized controlled trials
Bibliographic record
Abstract
ABSTRACT Objective To compare the effectiveness and safety of oral misoprostol vs vaginal dinoprostone for the induction of labor (IOL) using an individual participant data (IPD) meta‐analysis. Methods We used a Cochrane review and searched Ovid MEDLINE, Ovid Embase, Ovid Emcare, CINAHL Plus, Scopus and ClinicalTrials.gov to identify randomized controlled trials (RCTs) that compared oral misoprostol with vaginal dinoprostone for IOL in viable singleton pregnancies. We invited the authors of eligible trials to share their anonymized data. Primary outcomes were vaginal delivery, a composite measure of adverse maternal outcomes and a composite measure of adverse perinatal outcomes. IPD meta‐analysis was conducted using a two‐stage random‐effects model. An intention‐to‐treat approach was used for all analyses. Aggregate‐data meta‐analysis was undertaken with RCTs stratified by Trustworthiness in RAndomised Clinical Trials (TRACT) score. Results Of 18 eligible RCTs, eight provided IPD, of which five (1892 participants) met the TRACT criteria. IPD meta‐analysis showed similar rates of vaginal delivery after IOL with oral misoprostol or vaginal dinoprostone (odds ratio (OR), 0.99 (95% CI, 0.80–1.22); I 2 = 0%). The rates of composite adverse perinatal outcome (adjusted odds ratio (aOR), 1.02 (95% CI, 0.61–1.72); I 2 = 0%) and composite adverse maternal outcome (aOR, 1.39 (95% CI, 0.72–2.69); I 2 = 0%) were also comparable between the groups. Of 10 RCTs that did not share IPD, seven met the TRACT criteria. Aggregate‐data meta‐analysis of the 12 RCTs (five with IPD and seven without IPD) meeting the trustworthiness criteria also showed comparable rates of vaginal delivery after oral misoprostol and after vaginal dinoprostone (OR, 1.08 (95% CI, 0.92–1.27)). In contrast, six studies not meeting the trustworthiness criteria (three with and three without IPD) reported a higher rate of vaginal delivery following oral misoprostol (OR, 1.34 (95% CI, 1.22–1.48)), resulting in an inflated overall estimate of the vaginal delivery rate after oral misoprostol based on all data (OR, 1.19 (95% CI, 1.05–1.36)). Conclusion IOL with oral misoprostol or vaginal dinoprostone results in comparable rates of vaginal delivery and composite perinatal and maternal adverse outcomes. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.055 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.024 | 0.044 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".