Misoprostol in combination with transcervical Foley catheter shortens the induction-delivery interval

Medical study notes

Cervical ripening using misoprostol in combination with Foley catheter accelerates the induction as compared to misoprostol alone reports the results of a randomized control trial published in forthcoming issue of Journal of Obstetrics and Gynecology.

The duration of labor was shortened on an average by 3 hours in the combined misoprostol-catheter group.

A total of 200 women from Roosevelt Hospital, New York, New York were recruited over a period of 10 months and randomized to receive either misoprostol plus Foley catheter or misoprostol alone for induction of labor (100 in each arm). Women were matched for gestational age, parity, BMI, Bishop score and reason for induction of labor.

The women in the misoprostol only group received 25mcg of misoprostol per vagina every 4hours per the standard hospital protocol. Once the cervix becomes favorable or if the patient is in active labor, or if there is no progress for 24 hours, misoprostol administration was discontinued.

Women in the combination group received vaginal misoprostol per standard protocol. In addition, a Foley bulb was inserted digitally or by direct visualization with the use of a sterile speculum. The Foley was inserted through the internal os and filled with 60cc of normal saline. The catheter was taped to the patient's inner thigh under gentle traction.

Inclusion criteria were singleton fetus, intact membranes, cephalic presentation, Bishop score 6 or less and gestational age 37 weeks or more.

Patients with previous history of uterine surgery, non-assuring fetal heart tracing, multiple fetuses, contraindication to vaginal delivery or ruptured membranes were excluded from study.

All patients were closely followed up for total time to delivery as well as time to active phase, time from active phase to delivery, cesarean delivery rate, uterine tachysystole, estimated blood loss, chorioamnionitis, cord pH, 5-minute Apgar score, and neonatal intensive care unit admission.

The combined group average induction-delivery interval was 15.00 (11.0–21.8) hours as compared to 19.00 (14.0–27.3) hours in misoprostol only group (P= .001).

There were no significant differences in both the groups in terms of rate of cesarean delivery, PPH, infection or neonatal outcome.

The authors concluded that misoprostol in combination with Foley catheter effectively shortens induction to delivery process.

Abstract

ClinicalTrials.gov Identifier: NCT02566005