Sublingual Versus Vaginal Misoprostol for Cervical Ripening and Induction of Labour at Term in a Nigerian Population: A Comparative Clinical Study

ABSTRACT Induction of labour (IOL) is a critical obstetric intervention. This randomized trial at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria, compared the efficacy of 50 µg sublingual versus vaginal misoprostol (maximum four doses) for cervical ripening and IOL in 80 term pregnant women with unfavorable cervices (Bishop score < 6). The primary outcome was the rate of successful vaginal delivery. Both routes achieved high vaginal delivery rates (88. 8%). No significant differences were found in induction-to-delivery intervals (13. 85 vs 14. 27 hours, p=0. 787) or oxytocin augmentation rates. However, vaginal misoprostol resulted in significantly higher Bishop scores at 12 hours (p=0. 010), suggesting faster initial ripening. A significant limitation is the small sample size (n=80), which leaves the study underpowered to establish true clinical equivalence or detect differences in rare adverse events such as uterine tachysystole or fetal heart rate abnormalities, which were not robustly defined or reported. While both routes are effective in this setting, clinicians should individualize selection. Larger, adequately powered multi-center trials are required to confirm safety profiles and efficacy equivalence in resource-limited environments.