Misoprostol With Mechanical Dilation Versus Oxytocin With Mechanical Dilation for High-risk Pregnancy Inductions

Inclusion Criteria: * • Age \> 18 years old * Singleton, or twins with demise of one * Cephalic presentation * Intact membranes * Hypertension (chronic hypertension, gestational hypertension, pre-eclampsia with/without severe features, superimposed preeclampsia with/without severe features, eclampsia, HELLP) * Oligohydramnios (AFI\< 5cm and/or MVP \<2cm) * Fetal growth restriction (EFW or AC \<10th percentile) with normal or abnormal (elevated, absent, or reversed) Umbilical Artery Dopplers * Abnormal antenatal fetal testing (NST, Biophysical profile, decreased fetal movement) prompting induction of labor * Suspected placental abruption * Poorly controlled pre-gestational diabetes, defined as \>50% abnormal glucose values requiring increasing doses of anti-glycemic agents \>34 weeks, or requiring delivery * Gestational Age \> 22 weeks * Bishop score \< 6 Exclusion Criteria: * • Prior cesarean delivery * Allergy to misoprostol * Allergy to oxytocin * Allergy to silicone/latex * Contraindication to vaginal delivery including placenta or vasa previa, Placenta accreta/increta/percreta, prior uterine rupture, Prior myomectomy entering the uterine cavity and necessitating cesarean delivery, active genital herpes, transverse or oblique fetal lie, umbilical cord prolapse, or HIV viral load \>1000 copies/mL