Simultaneous use of high‐volume Foley catheter (60 ml) and misoprostol for labor induction in nulliparous women: A randomized controlled trial

Abstract

Induction of labor (IOL) is a common obstetrical intervention and has increased significantly in recent years. 1,2 However, IOL in an unfavorable cervix may lead to increased maternal, fetal, and neonatal complications such as prolonged induction to delivery interval (IDI), and prolonged latent phase of labor and active labor resulting in increased incidence of cesarean section (CS), chorioamnionitis, birth asphyxia, and poor Apgar score in the newborn requiring hospitalization in the neonatal intensive care unit (NICU).Transcervical Foley catheter (FC) is an inexpensive mechanical method for IOL in women with unfavorable cervix. It mechanically

A randomized controlled trial comparing combined medical and mechanical method for early mid‐trimester abortion (13–20 weeks)

“…Also, we preferred FC (instead of laminaria tents), an easily available and cheap agent for mechanical dilatation. The FC bulb was inflated to 60 ml (high‐volume FC; 60–80 ml) as literature on labor induction of term pregnancy shows a higher volume of FC to be associated with better cervical ripening and shorter induction delivery interval 7,9 …”

“…As per the randomization sequence, women in group 2 ( n = 30) had insertion of FC (16‐french) (simultaneously with the first dose of vaginal misoprostol) (Foley trac; Romsons Group Private Ltd.) inserted through the cervix into the extra‐amniotic space with the bulb inflated with 60 ml of normal saline, under sterile aseptic precautions. The FC was taped to the inner thigh of the woman under slight traction 7 …”

“…The FC bulb was inflated to 60 ml (high-volume FC; 60-80 ml) as literature on labor induction of term pregnancy shows a higher volume of FC to be associated with better cervical ripening and shorter induction delivery interval. 7,9 FC act by both mechanical dilatation and endogenous prostaglandin release. 9 Subsequent use of high-volume FC (60 ml; 48 h it was presumed that it would have minimal, if any, effect on the overall duration of IAI, in the presence of well-defined protocols of MTA.…”

“…5 Simultaneous use of FC with oral misoprostol (swallowed piecemeal) has been shown to act synergistically for labor induction in women at term with statistically significant reduction (3 h) in induction-to-delivery interval (IAI; 860 min, interquartile range [IQR] 840-940 min vs. 1160 min, IQR 1080-1320 min, P < 0.001). 7 Additionally, larger volumes of FC (60-80 ml) for cervical ripening decrease the total time from cervical ripening and induction to delivery in pregnant women at term. 8,9 Traditionally, osmotic dilators have been used for MTA but without significant benefit.…”

“…Recently, there has been renewed interest in mechanical methods for induction of labor in pregnant women at term. 7 Among these, Foley catheter (FC) is a relatively inexpensive and easily available mechanical method used worldwide. 5 Simultaneous use of FC with oral misoprostol (swallowed piecemeal) has been shown to act synergistically for labor induction in women at term with statistically significant reduction (3 h) in induction-to-delivery interval (IAI; 860 min, interquartile range [IQR] 840-940 min vs. 1160 min, IQR 1080-1320 min, P < 0.001).…”