Background: Labor is a natural physiological process, but prolonged or obstructed labor can lead to significant maternal and fetal complications, especially in developing countries. Augmentation of labor is often necessary to prevent these complications. Traditionally, intravenous oxytocin has been the preferred method for labor augmentation, but oral misoprostol has emerged as a potential alternative due to its ease of administration. This study aims to compare the efficacy, safety, and outcomes of oral misoprostol versus intravenous oxytocin in labor augmentation among primigravidae at term. Materials and Methods: This prospective study was conducted at NRS Medical College and Hospital, Kolkata, over a period of one year from May 2011 to April 2012. A total of 100 primigravidae with singleton pregnancies and inadequate uterine contractions were randomly assigned to receive either oral misoprostol (25 mcg every 4 hours, up to three doses) or intravenous oxytocin infusion. The primary outcomes measured were augmentation-delivery interval, mode of delivery, and neonatal outcomes. Secondary outcomes included maternal complications such as postpartum hemorrhage and uterine hypertonicity. Results: The average augmentation-delivery interval was shorter in the misoprostol group (5.2 hours) compared to the oxytocin group (5.5 hours). Normal vaginal delivery rates were 80% in the misoprostol group and 82% in the oxytocin group. There was no significant difference in the incidence of cesarean section between the groups (14% each). The misoprostol group had a higher incidence of fetal distress (12% vs. 2%), meconium-stained liquor (14% vs. 2%), and tachysystole (12% vs. 2%). Neonatal outcomes, including Apgar scores and NICU admissions, were similar between the groups. Conclusion: Both oral misoprostol and intravenous oxytocin effectively augment labor in primigravidae at term. While misoprostol offers ease of administration, it is associated with a higher incidence of fetal distress and tachysystole. Overall, there is no significant difference in maternal or neonatal outcomes between the two methods. Future studies should focus on optimizing misoprostol dosing to minimize adverse effects while maintaining efficacy.