Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis

Lee, Howard Hao; Huang, Ben-Shian; Chen, Min; Yeh, Chien-Yuh; Lin, I-Chia; Horng, Huann-Cheng; Huang, Hsin-Yi; Lee, Wen-Ling; Wang, Peng Hui

doi:10.3390/ijerph17061825

Cited by 30 publications

(13 citation statements)

References 68 publications

(97 reference statements)

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“…As a matter of fact, the use of intracervical FC plus vaginal misoprostol has been compared with vaginal misoprostol alone in a very recent meta-analysis. In this study, Lee et al showed that induction time, uterine tachysystole, and meconium staining decrease with the combination of FC and vaginal misoprostol compared to misoprostol alone with no difference regarding the C-section rate (25).…”

Section: Discussionmentioning

confidence: 60%

Vaginal Misoprostol Versus Intracervical Foley Catheter for Cervical Ripening in Postdate Primigravid Women: a Randomized Clinical Trial

Abdi

Alavi

Pakbaz

et al. 2021

Preprint

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Background: Being one of the most common indications of labor induction, postdate pregnancy can lead to serious maternal and fetal complications. In this study we aimed to compare vaginal misoprostol with intracervical Foley catheter (FC) for cervical ripening in postdate primigravid women. Methods: This randomized clinical trial included 120 primigravid women aged 18-35 years with singleton and postdate pregnancies and Bishop score ≤4. Participants were randomized into two equal groups. The first group received 25 µg vaginal misoprostol and the second group had an 18 Fr FC inserted into their cervical canal. Labor induction was performed using oxytocin in both groups if progression of labor or true contractions did not occur within 6 hours of the interventions. In case of nonreassuring fetal heart rate, fetal distress, placental abruption, or prolonged labor, C-section was performed. Results: The frequency of NVD, C-section, meconium-stained amniotic fluid, and neonatal intensive care unit admission did not differ significantly between groups. Placental abruption and uterine tachysystole occurred more frequently in the misoprostol group (15.0 vs. 1.7%, P=0.008 and 21.7 vs. 0.0%, P<0.001, respectively). A significantly higher number of women in the FC group required oxytocin (73.3 vs. 41.7%, P<0.001). Duration of labor was significantly higher in the FC group (P=0.001). Conclusions: Due to the lower rate of placental abruption and uterine tachysystole observed with FC, it appears to be superior to vaginal misoprostol for cervical ripening in postdate primigravid women; however, its longer labor duration and higher oxytocin requirement should be taken into consideration. Trial registration: Iranian Registry of Clinical Trials, IRCT20181218042033N4. Registered 19/04/2020. Retrospectively registered, https://www.irct.ir/trial/47037

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Section: Discussionmentioning

confidence: 60%

Vaginal Misoprostol Versus Intracervical Foley Catheter for Cervical Ripening in Postdate Primigravid Women: a Randomized Clinical Trial

Abdi

Alavi

Pakbaz

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Vaginal misoprostol versus intracervical Foley catheter for cervical ripening in postdate primigravid women: a randomized clinical trial

Abdi

Alavi

Pakbaz

et al. 2021

BMC Pregnancy Childbirth

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Background Being one of the most common indications of labor induction, postdate pregnancy can lead to serious maternal and fetal complications. In this study we aimed to compare vaginal misoprostol with intracervical Foley catheter (FC) for cervical ripening in postdate primigravid women. Methods This randomized clinical trial included 120 primigravid women aged 18–35 years with singleton, postdate pregnancies, and Bishop score ≤ 4. Participants were randomized into two equal groups. The first group received 25 µg vaginal misoprostol and the second group had an 18 Fr FC inserted into their cervical canal. Labor induction was performed using oxytocin in both groups if progression of labor or true contractions did not occur within 6 h of the interventions. In case of nonreassuring fetal heart rate, fetal distress, placental abruption, or prolonged labor, C-section was performed. Results The frequency of normal vaginal delivery, Cesarean section, meconium-stained amniotic fluid, and neonatal intensive care unit admission did not differ significantly between groups. Placental abruption and uterine tachysystole occurred more frequently in the misoprostol group (15.0 vs. 1.7%, P = 0.008 and 21.7 vs. 0.0%, P < 0.001, respectively). A significantly higher number of women in the FC group required oxytocin (73.3 vs. 41.7%, P < 0.001). Duration of labor was significantly higher in the FC group (P = 0.001). Conclusions Due to the lower rate of placental abruption and uterine tachysystole observed with FC, it appears to be superior to vaginal misoprostol for cervical ripening in postdate primigravid women; however, its longer labor duration and higher oxytocin requirement should be taken into consideration. Trial registration Iranian Registry of Clinical Trials, IRCT20181218042033N4. Registered 19/04/2020. Retrospectively registered, https://www.irct.ir/trial/47037

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“…A two-sided p -value of ≤0.05 was regarded as statistically significant. Comprehensive Meta-analysis Version 3.0 (Biostat Inc., Englewood, NJ, USA) was used for data synthesis [ 68 ]. A random effect model was used to calculate effect size in meta-analysis due to potential clinical heterogeneity from different surgical indications and investigated populations.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of Applying Hyaluronic Acid Gels in the Primary Prevention of Intrauterine Adhesion after Hysteroscopic Myomectomy: A Meta-Analysis of Randomized Controlled Trials

Chen

Chang

Yang

et al. 2020

Life

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Intrauterine adhesion (IUA), which mainly occurs after intrauterine surgery or an inflammatory process, is an important but often neglected condition in women of reproductive age. The presentation of IUA varies greatly, ranging from symptom-free to severe, with amenorrhea or infertility. With much advanced development of intrauterine instruments, more intrauterine diseases can be successfully cured by hysteroscopic surgery. Among these, submucosal myoma is one of the best examples. Submucosal myomas are often related to abnormal bleeding, anemia, and possible infertility or miscarriage. However, submucosal myoma after hysteroscopic myomectomy may be complicated by IUA in various grades of severity, and its incidence and prevalence might be nearly one-quarter to one-third of patients, suggesting an urgent need for efforts to decrease the risk of developing IUA after hysteroscopic myomectomy. Many strategies have been reported to be useful for this purpose, and intrauterine application of anti-adhesive gels, such as polyethylene oxide–sodium carboxymethylcellulose (PEO-NaCMC) or auto-crosslinked hyaluronic acid (ACHA), has become increasingly popular in routine clinical practice. This meta-analysis is aimed at investigating the effect of ACHA on the primary prevention of IUA formation after hysteroscopic myomectomy. A pooled analysis of three studies (hysteroscopic surgeries for fibroids, polyps, and septum) including 242 women showed that using PEO-NaCMC or ACHA gel decreased the IUA rate with an odds ratio (OR) of 0.364 (95% confidence interval (CI) 0.189–0.703, p = 0.03). Pooled analysis of two studies that limited the use of ACHA in 119 women showed that the application of ACHA gel for the primary prevention of IUA in patients after hysteroscopic myomectomy led to a statistically significant reduction of the development of IUA postoperatively (OR 0.285, 95% CI 0.116–0.701, p = 0.006). All of this suggests that the use of ACHA gel in patients after hysteroscopic myomectomy could significantly reduce de novo IUA, although more evidence is needed.

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Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis

Cited by 30 publications

References 68 publications

Vaginal Misoprostol Versus Intracervical Foley Catheter for Cervical Ripening in Postdate Primigravid Women: a Randomized Clinical Trial

Vaginal Misoprostol Versus Intracervical Foley Catheter for Cervical Ripening in Postdate Primigravid Women: a Randomized Clinical Trial

Vaginal misoprostol versus intracervical Foley catheter for cervical ripening in postdate primigravid women: a randomized clinical trial

Efficacy of Applying Hyaluronic Acid Gels in the Primary Prevention of Intrauterine Adhesion after Hysteroscopic Myomectomy: A Meta-Analysis of Randomized Controlled Trials

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