Effect of the Foley catheter and synchronous low dose misoprostol administration on cervical ripening: A randomised controlled trial

Abstract

This randomised controlled trial was carried out over a 14-month period in a tertiary health institution in Nigeria, to determine the effectiveness of Foley catheter and synchronous low dose misoprostol for pre-labour cervical ripening. Term pregnant women with unfavourable cervices (Bishop's score < 6) requiring cervical ripening/induction of labour were assigned randomly into three groups: Group A, transcervical Foley catheter was used synchronously with low dose intravaginal misoprostol; Group B, transcervical Foley catheter alone was used and Group C, low dose intravaginal misoprostol alone was used. The time to achieve a favourable cervical status as well as vaginal delivery was significantly shorter in the synchronous group than in the control groups (p < 0.05). The synchronous use of Foley catheter and misoprostol is very effective in cervical ripening and should be considered in clinical situations where there is need to hasten vaginal delivery in the presence of an unripe cervix.

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

“…Four [15–18] were excluded because the treatment allocation was not randomized, one [19] was excluded because the full text could not be obtained, two [20,21] were excluded because they involved induction of labor in pregnancies with a nonviable fetus, and one [22] was excluded because misoprostol was not used concurrently with a Foley catheter in the combination treatment group. Therefore, eight eligible studies [9–12,23–26] with a total of 1153 patients were included in the present meta‐analysis (Table 1).…”

“…Among the included studies, seven [9–12,23–25] had a low risk of random sequence generation and allocation concealment and were judged to be of high quality (Table 2). One study [26] was judged to be of low quality.…”

“…All studies reported the time from induction to delivery. However, Ugwu et al [23] reported the data as patient numbers per time interval; because of this format, the data could not be pooled with those from the other studies. On the basis of random‐effects estimation, the use of Foley catheter plus misoprostol (combination group) was associated with a shorter mean time to delivery than was misoprostol alone, but the difference did not reach statistical significance (mean difference –1.46 hours, 95% CI –3.72 to 0.81; P = 0.21) (Fig.…”

Safety of the balloon catheter for cervical ripening in outpatient care: complications during the period from insertion to expulsion of a balloon catheter in the process of labour induction: a systematic review

“…20 In other women, the bleeding resolved spontaneously and induction with the catheter was continued. 10,21 In three cases a caesarean section (CS) was performed due to severe bleeding and in one woman due to a marginal placenta praevia. 18,19,22 Two of these neonates had good Apgar scores and information of the third one was not available to us.…”

Women's Experiences with and Preference for Induction of Labor with Oral Misoprostol or Foley Catheter at Term

“…They did not find differences in the likelihood to choose the same method of cervical ripening for possible future inductions (91 vs. 100%; p ¼ 0.08). 18 Another explanation could be that more vaginal examinations were performed in the oral misoprostol group (mean: 8.1 vs. 6.8), thereby creating more contact moments with the attending physician that could lead to more satisfaction with the induction experience instead of the previously assumed disadvantage of vaginal examinations. Different cultural perceptions of induction of labor might influence the preference for an induction method.…”