What is the best method for labor induction in patients with a second trimester fetal demise?

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Abstract

EVIDENCE-BASED ANSWER

In this clinical scenario, sublingual misoprostol results in delivery more rapidly than vaginal misoprostol. Vaginal misoprostol, vaginal PGE2, and vaginal PGF2alpha are all similarly effective in achieving induction, but vaginal misoprostol has fewer gastrointestinal (GI) side effects than PGE2 and PGF2alpha (SOR: A, meta-analysis of RCTs). Use of a Foley catheter with or without oxytocin and/or misoprostol is associated with an increased risk for cesarean delivery. Adding laminaria to misoprostol is not associated with faster delivery (SOR: B, retrospective cohort studies).

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