Foley catheter vs oral misoprostol for induction of labor: individual participant data meta‐analysis

Abstract

Objective To compare the effectiveness and safety of Foley catheter and oral misoprostol for induction of labor (IOL). Methods The Cochrane Review on Mechanical Methods for Induction of Labour and Ovid MEDLINE, EMBASE via Ovid, Ovid Emcare, CINAHL Plus, http://ClinicalTrials.gov and Scopus, from inception to April 2019, were searched for randomized controlled trials (RCTs) comparing Foley catheter to oral misoprostol for IOL in viable singleton gestations. Eligible trials for which raw data were obtained were included and individual participant data meta‐analysis was performed. Primary outcomes were vaginal birth, a composite of adverse perinatal outcome (including stillbirth, neonatal death, neonatal seizures, admission to the neonatal intensive care unit, severe respiratory compromise or meconium aspiration syndrome) and a composite of adverse maternal outcome (including admission to the intensive care unit, maternal infection, severe postpartum hemorrhage, maternal death or uterine rupture). The quality of the included RCTs was assessed using the Cochrane Risk of Bias 2 tool and the certainty of evidence was evaluated using the GRADE approach. A two‐stage random‐effects model was used for meta‐analysis according to the intention‐to‐treat principle and interactions between treatment and baseline characteristics were assessed. Results Of seven eligible trials, four provided individual participant data for a total of 2815 participants undergoing IOL, of whom 1399 were assigned to Foley catheter and 1416 to oral misoprostol. All four trials provided data for each of the primary outcomes in all 2815 women. Compared with those receiving oral misoprostol, Foley catheter recipients had a slightly decreased chance of vaginal birth (risk ratio (RR), 0.95 (95% CI, 0.91–0.99); I2, 2.0%; moderate‐certainty evidence). A trend towards a lower rate of composite adverse perinatal outcome was found in women undergoing IOL using a Foley catheter compared with oral misoprostol (RR, 0.71 (95% CI, 0.48–1.05); I2, 14.9%; low‐certainty evidence). Composite adverse maternal outcome did not differ between the groups (RR, 1.00 (95% CI, 0.97–1.03); I2, 0%; moderate‐certainty evidence). Meta‐analyses of effect modifications did not show significant interactions between intervention and parity or gestational age for any of the primary outcomes. Conclusions For women undergoing IOL, Foley catheter is less effective than oral misoprostol, as it was associated with fewer vaginal births. However, while we found no significant difference in maternal safety, Foley catheter induction may reduce adverse perinatal outcomes. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Evaluating misoprostol and mechanical methods for induction of labour

“…Similar clinical outcomes have been reported when comparing a balloon catheter with vaginal misoprostol, but results have lacked statistical power. An individual participant data meta‐analysis of four studies 16 reported that women induced with oral misoprostol had a higher chance of vaginal birth than those induced with the Foley catheter; there were no other differences in outcomes.…”

Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials

“…Developed originally in 1964, the Bishop score remains a widely used predictive tool for vaginal delivery in women undergoing IOL. Many studies have investigated how best to conduct IOL, using different mechanical and pharmacological methods to help achieve vaginal delivery, based on the Bishop score [4][5][6][7][8][9][10][11] . However, identifying patients at the highest risk of CS following IOL is important for patient counseling and will aid in the application of these thoroughly investigated induction techniques.…”

Prostaglandins in the induction of labour – do we have the optimal substance, dose, and route of administration? Literature review

“…Despite increasing the chance of a vaginal delivery the authors found a trend toward increasing adverse perinatal outcome in the misoprostol group. The study showed no difference in adverse maternal outcome [29]. The only form of misoprostol registered for induction of labour is MVI 200 μg.…”