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Induction of labour (IOL) is an increasingly common obstetric intervention globally. There is a choice of mechanical or pharmacological methods for induction of labour when the cervix is unfavorable. Which approach is both effective and safe however is not clear due to how trials are designed and reported. A tradeoff between the common primary outcomes of vaginal birth or time to delivery and rare safety outcomes mean trials are underpowered to determine both. There is also a lack of reporting of the indications for the operative births