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

Abstract

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

Comparison between effectiveness of sublingual misoprostol and intracervical dinoprostone gel for induction of labour in pregnant women

“…A randomized controlled trial by Agha et al compared sublingual misoprostol with dinoprostone gel for induction of labor and found that both methods were equally effective for cervical ripening and labor induction. 11 However, the misoprostol group had a higher incidence of hyperstimulation, meconium-stained amniotic fluid, and fetal distress.…”

Effect of Frequent Vaginal Saline Lavage On Maternal Infection Prevention During Mechanical Labor Induction

“…Although mechanical devices induce cervical ripening without causing uterine contractions, the main argument against the usages is that the procedure lead to longer labor duration [22], and it introduces a foreign device into the cervix, bringing in local organisms that may cause maternal and neonatal infections, despite undertaking standard aseptic measures [7][8].…”

Effect of cervical Bishop score on induction of labor at term in primiparas using Foley catheter balloon: a retrospective study

“…Mechanical methods have been recommended by many institutions, such as the ACOG [6], WHO [7] and Canada IOL guide lines [8]. Previous studies have found that the mechanical methods were as effective as pharmacological methods in achieving vaginal delivery [3,[9][10][11][12][13].…”