This study compared two drugs (PGE1 and PGE2) used to start labor after a fetal death in the third trimester. It found that PGE1 leads to a quicker delivery and shorter labor, while PGE2 often needs extra oxytocin and takes longer, but pain was higher with PGE1. No major safety differences were seen.

<b>Objectives</b>: The aim of our study was to assess the efficacy and safety of two different labor induction methods in patients after fetal demise beyond 28 weeks, with an unfavorable cervix: misoprostol-prostaglandin E1 analog (PGE1) and dinoprostone-prostaglandin E2 analog (PGE2). <b>Methods</b>: This retrospective single-center cohort study included all labor cases after fetal demise (intrauterine fetal death or termination of pregnancy with feticide) from 28 to 40 weeks of gestation, where labor was induced by either PGE1 or PGE2. The primary outcome was the induction-to-delivery time interval. Secondary outcomes included the proportion of patients who delivered within 24 h, the failed induction rate, the length of labor, pain during induction, the adverse outcome rate, and the post-labor hospital stay. <b>Results</b>: The induction-to-delivery time interval was shorter in the PGE1 group (<i>p</i> = 0.048). There was no statistically significant difference in the proportion of patients who delivered within 24 h (<i>p</i> = 0.651) and failed inductions (<i>p</i> = 0.18) between groups. The duration of labor was longer in the PGE2 group (<i>p</i> = 0.01). Oxytocin augmentation was more common in the PGE2 group (<i>p</i> &lt; 0.001). Pain during induction was greater in women in the PGE1 group (<i>p</i> &lt; 0.001). There were no statistically significant differences in adverse effects between groups. There was no significant difference in induction to delivery interval between the two methods when comparing lower and higher gestational ages (28 to 34 weeks, <i>p</i> = 0.18; 35 to 40 weeks, <i>p</i> = 0.343). <b>Conclusions</b>: Our findings support the use of a PGE1 regimen for third-trimester labor induction after fetal demise, when no contraindications exist. This approach appears to improve the efficiency of induction and may enhance overall patient care by reducing intervention needs.