Meta‐analysis of Foley catheter plus misoprostol versus misoprostol alone for cervical ripening

Abstract

The combined use of Foley catheter and misoprostol results in a reduced time to delivery, a reduced frequency tachysystole with fetal heart rate changes, and an increased incidence of chorioamnionitis.

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

“…Unlike Chen et al's analysis showing the increased risk of chorioamnionitis in women with intracervical Foley catheter [16], risk for chorioamnionitis was not increased with intracervical Foley catheter in our current study. This is perhaps due to the rupture of membrane being excluded from our study, since some studies have shown that rupture of membrane is a known risk factor for infection [63].…”

“…This meta-analysis of 8 randomized controlled trials with 1110 women showed that combined use of Foley catheter and intravaginal misoprostol for induction of pregnancy leads to faster induction time with no increase in caesarean section rate as well as decreased risk for tachysystole and meconium when compared to intravaginal misoprostol alone. These findings are mostly in line with a previous 2015 meta-analysis, which also showed decreased induction time for combined Foley catheter and misoprostol use [16].…”

“…However, there have been other studies that showed a lack of such synergistic effect [54,55], while another study showed no significant benefits to the induction-delivery time but did reduce complications such as uterine hyper stimulation [51]. A meta-analysis in 2015 by Chen et al showed that combined use of Foley catheter plus misoprostol is associated with a shorter mean time to delivery and reduced tachysystole, but increased clinical suspicion of chorioamnionitis when compared to misoprostol alone, but it included oral misoprostol [16]. Furthermore, Chen's meta-analysis included studies with premature rupture of membrane, which affects induction times.…”

Cervical ripening and induction of labour: Inpatient or outpatient, oral misoprostol or Foley catheter?

“…However, the combination of a Foley catheter with vaginal misoprostol could lead to an increased risk of chorioamnionitis, probably due to the increased number of vaginal examinations involved with the administration of vaginal misoprostol [29]. The combination of a Foley catheter with low dose oral misoprostol is reported to be more effective and has shorter induction delivery interval than vaginal misoprostol [30].…”

Authors' reply re: A systematic review and network meta‐analysis comparing the use of Foley catheters, misoprostol and dinoprostone for cervical ripening in induction of labour

“…Our previous review concluded that the combined use of Foley catheter and misoprostol for cervical ripening results in a reduced time to delivery, and a reduced frequency of tachysystole with fetal heart rate changes. On the other hand, an increased incidence of chorioamnionitis was observed compared with misoprostol alone . However, a recent randomised controlled trial comparing labour induction with oral misoprostol and Foley catheter revealed no difference in the rate of maternal intrapartum infection .…”