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Misoprostol for Cervical Ripening and Induction of Labour: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines

Last updated: November 23, 2018
Project Number: RC1047-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of misoprostol for cervical ripening and induction of labour?
  2. What is the cost-effectiveness of misoprostol for cervical ripening and induction of labour?
  3. What are the evidence-based guidelines regarding misoprostol for cervical ripening and induction of labour?

Key Message

Evidence from meta-analyses, Canadian guidelines, and randomized controlled trials suggests that misoprostol is likely effective and safe for induction of labour and cervical ripening. Limitations include the heterogeneity between administration methods and dosages of induction regimes (both misoprostol and comparators). Economic trials indicate that titrated oral low-dose misoprostol and buccal/sublingual misoprostol are cost-effective methods for induction of labour when compared to other pharmacological interventions; however none of the cost studies were performed in the Canadian setting.