A Randomized Clinical Trial Comparing Vaginal Misoprostol versus Cervical Foley Plus Oral Misoprostol for Cervical Ripening and Labor Induction

Abstract

We compared labor induced by vaginal misoprostol versus a supracervical Foley catheter and oral misoprostol. Singleton pregnancies at > or = 24 weeks' gestation were randomized to either an initial 25-microg dose of intravaginal misoprostol, followed by 50-microg intravaginal doses at 3- to 6-hour intervals, or a supracervical Foley balloon and 100 microg of oral misoprostol at 4- to 6-hour intervals. Primary outcome was time from induction to delivery. One hundred twenty-six women were randomized to vaginal misoprostol alone (group I) and 106 women to Foley and oral misoprostol (group II). The groups were similar in age, weight, gestational age, parity, indication for induction of labor, and oxytocin use. Cesarean delivery rates at 37% and cesarean indications were similar ( P = 0.25). The time from induction to delivery in group II (12.9 hours) was significantly shorter than that in group I (17.8 hours, P < 0.001). Uterine tachysystole occurred less often in the vaginal misoprostol group (21% versus 39%, P = 0.015). Compared with vaginal misoprostol, delivery within 24 hours was significantly more likely with a Foley balloon and oral misoprostol. The use of terbutaline and peripartum outcomes were similar in the two groups.

Induction of labor in prolonged pregnancy with unfavorable cervix: comparison of sequential intracervical Foley catheter–intravaginal misoprostol and intravaginal misoprostol alone

“…About neonatal indices, the two groups were comparable as there was no significant difference in outcome. This favorable outcome has been documented in studies evaluating the efficacy of various methods of induction combining pharmacological and mechanical techniques [12,14,15].…”

Mechanical and Pharmacologic Methods of Labor Induction

“…The Foley bulb was placed just above the level of the internal os and inflated with 60cc of sterile water. 6, 7, 11, 14 The catheter was taped to the inner thigh with gentle traction and deflated and removed after 12 hours if still in place. The oxytocin protocol was initiated once the Foley bulb was no longer in place (Appendix 2, http://links.lww.com/xxx).…”

“…3, 4 Plausibly, combining both mechanical and pharmacologic methods may have a synergistic effect in achieving labor. Some studies have shown promise in reducing labor time and risk of cesarean delivery with combination methods, 6, 7 while others have not. 8–11 …”

Labor Induction With a Foley Balloon Inflated to 30 mL Compared With 60 mL

“…6 Multiple studies have shown no consistent association between Foley catheter use and these risks, although is it generally accepted that low-lying placenta is a relative contraindication for Foley catheter placement because of concern for potential disruption of the placental edge resulting in maternal hemorrhage. [7][8][9][10][11][12][13] Embrey and Mollison 14 first described the use of a transcervical Foley catheter for labor induction in 1967 using a 26 gauge Foley with a 50-mL balloon. Since this initial study, balloon inflation sizes of 30 -80 mL have been reported in the literature with inconsistent results regarding induction-to-delivery duration and risk of cesarean delivery.…”