Castor oil plus sweeping membrane maneuver versus oral Misoprostol for labor induction: a prospective observational study

<title>Abstract</title> <p> <bold>Background</bold> Labor induction is a common procedure in obstetric practice, required to terminate pregnancy in several clinical conditions. Oral prostaglandins are frequently used, but require close monitoring of maternal-fetal well-being. Castor oil administration plus membrane sweeping represents a simple, non-pharmacological alternative that can potentially reduce monitoring needs and overall induction costs. <bold>Methods</bold> A prospective observational study was conducted on 169 term pregnant women indicated for labor induction. Participants were divided into two groups: 100 received 60 mL castor oil plus membrane sweeping; 69 received oral misoprostol. The primary outcome was active labor onset within 24 hours; other outcomes included maternal-fetal safety parameters, induction-to-delivery time and secondary medical interventions. <bold>Results</bold> Labor onset within 24 hours was achieved in a similar percentage of patients between groups (59.2% non-pharmacological vs. 56.1% misoprostol). Given a comparable induction-to-delivery interval, the non-pharmacological strategy was associated with a significant reduction in secondary medical interventions (oxytocin use, amniorexis, epidural analgesia). Overall, safety profiles were comparable regarding delivery mode and neonatal outcomes, although the misoprostol group had an higher incidence of uterine tachysystole. Patients who crossed over from non-pharmacological to the misoprostol group showed no differences in Bishop score variation or doses of misoprostol required compared to pharmacological group, suggesting that the initial “natural” approach didn’t negatively affect subsequent clinical management. <bold>Conclusions</bold> The combination of castor oil plus membrane sweeping is a simple, safe and promising alternative strategy to pharmacological induction with Misoprostol. It may offer advantages in reducing secondary medical interventions and lowering economical costs of induction. </p>