Objective. To compare the efficacy and safety of oral prostaglandin in solution versus vaginal prostaglandin gel for labor induction. Design. A retrospective study. Methods. Data from original obstetric records at a university hospital in Sweden 2012-2013. Results. In all women, oral prostaglandin resulted in vaginal birth <24 hours in 66% compared to 80% with vaginal prostaglandin (p < 0.001), and cesarean section in 19% versus 32% (p = 0.02). In primiparous women, oral prostaglandin was followed by vaginal birth <24 hours in 54% compared to 71% (p = 0.01), and cesarean section in 25% versus 41% (p = 0.03). In women with an unripe cervix, oral prostaglandin lead to vaginal birth <24 hours in 66% compared to 79% (p = 0.01), and cesarean section in 21% versus 33% (p = 0.04). Despite a longer induction to vaginal delivery interval with oral prostaglandin, the rates of obstetric bleeding, chorioamnionitis, uterine hyperstimulation and neonatal asphyxia were not increased. Conclusions. Oral prostaglandin in solution was less effective than vaginal prostaglandin gel in achieving vaginal birth <24 hours. However, oral prostaglandin was safer, since it resulted in fewer cesarean sections without increasing maternal morbidity or neonatal asphyxia.