Misoprostol With Mechanical Dilation Versus Oxytocin With Mechanical Dilation for High-risk Pregnancy Inductions

This is a single center randomized control trial of two arms. Singleton, cephalic, high risk pregnancies will be randomized to either oxytocin with mechanical dilation versus misoprostol with mechanical dilation.

In group A, receiving misoprostol with mechanical dilation, will serve as the control group. Group B, oxytocin with mechanical dilation, will serve as the experimental group. The expected duration of participation begins at induction of labor and concludes at time of delivery.

Inclusion criteria

• • Age > 18 years old

• Singleton, or twins with demise of one
• Cephalic presentation
• Intact membranes
• Hypertension (chronic hypertension, gestational hypertension, pre-eclampsia with/without severe features, superimposed preeclampsia with/without severe features, eclampsia, HELLP)
• Oligohydramnios (AFI< 5cm and/or MVP <2cm)
• Fetal growth restriction (EFW or AC <10th percentile) with normal or abnormal (elevated, absent, or reversed) Umbilical Artery Dopplers
• Abnormal antenatal fetal testing (NST, Biophysical profile, decreased fetal movement) prompting induction of labor
• Suspected placental abruption
• Poorly controlled pre-gestational diabetes, defined as >50% abnormal glucose values requiring increasing doses of anti-glycemic agents >34 weeks, or requiring delivery
• Gestational Age > 22 weeks
• Bishop score < 6

Exclusion criteria

• • Prior cesarean delivery

• Allergy to misoprostol
• Allergy to oxytocin
• Allergy to silicone/latex
• Contraindication to vaginal delivery including placenta or vasa previa, Placenta accreta/increta/percreta, prior uterine rupture, Prior myomectomy entering the uterine cavity and necessitating cesarean delivery, active genital herpes, transverse or oblique fetal lie, umbilical cord prolapse, or HIV viral load >1000 copies/mL