ACOG recommends the use of oral or vaginal misoprostol, vaginal dinoprostone (either gel or insert), or mechanical methods for cervical ripening. Plus, it states, “Combination methods (pharmacologic and mechanical) are also effective”. The July 2026 ACOG CPG 9 states this regarding vaginal misoprostol compared to vaginal dinoprostone for labor induction: “Vaginal dinoprostone is effective for cervical ripening; however, vaginal misoprostol has higher efficacy and less need for oxytocin augmentation. The Cochrane database systematic review in 2010 that compared vaginal misoprostol with vaginal dinoprostone in 38 trials (7,022 participants) showed a lower rate of failure to achieve vaginal delivery in 24 hours (RR 0.77) and reduced need for oxytocin augmentation with misoprostol (RR 0.68). There were no differences in the rates of cesarean delivery ...