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| 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.
ClinicalTrials.gov
Identifier: NCT02566005
