Induction of Labor Using a Foley Catheter or Misoprostol: A Systematic Review and Meta-analysis

Abstract

In women with an unripe cervix at term, Foley catheter seems to have a better safety profile than misoprostol (any dose, any administration route) for induction of labor. Larger studies are needed to investigate the safety profile of a Foley catheter compared to separate dosing and administration regimens of misoprostol.

Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A Meta-Analysis

“…Furthermore, Chen's meta-analysis included studies with premature rupture of membrane, which affects induction times. Another meta-analysis by Eikelder et al in 2016, which looked mainly at the safety profiles for both induction methods, showed that there was less uterine hyperstimulation in the combination group [15]. Moreover, a subgroup analysis with Foley catheter plus 25 µg vaginal misoprostol versus 25 µg vaginal misoprostol only also found less hyperstimulation in the combination group, although it did not reach statistical significance.…”

“…There are two main methods of cervical ripening. One is mechanical, including (1) the introduction of a catheter through the cervix into the extra-amniotic space with balloon insufflation; (2) introduction of laminaria tents, or their synthetic equivalent (Dilapan), into the cervical canal; (3) use of a catheter to inject fluid into the extra-amniotic space (EASI), and the other is pharmacological [1,7,8,14,15,[26][27][28][29][30]. Intracervical Foley catheter is the most common mechanical method that was first described by Embrey and Mollison in 1967, where a Foley is inserted into the cervical canal and dilated just past the internal os with mild traction outward dilating the cervix directly, as well as indirectly stimulating prostaglandin (PG) and oxytocin secretion [31][32][33][34][35][36][37][38].…”

“…Moreover, a subgroup analysis with Foley catheter plus 25 µg vaginal misoprostol versus 25 µg vaginal misoprostol only also found less hyperstimulation in the combination group, although it did not reach statistical significance. However, time to delivery was not analyzed in this meta-analysis [15]. A 2019 Cochrane review was also performed encompassing several mechanical methods and pharmaceutical methods as well as extensive analysis various combinations including "any mechanical methods and low dose misoprostol versus low dose misoprostol alone" [1].…”

MEchanical DIlatation of the Cervix­­ in a Scarred uterus (MEDICS): the study protocol of a randomised controlled trial comparing a single cervical catheter balloon and prostaglandin PGE2 for cervical ripening and labour induction following caesarean delivery

“…There is concern, however, that IOL with prostaglandins may increase scar rupture rates up to fivefold in women with previous CS compared with spontaneous labour, leading to various professional bodies discouraging prostaglandin induction in the presence of a uterine scar 6 14 16. More recent cohort studies and meta-analyses have shown that these increased rates are seen only with prostaglandin E1 and not with prostaglandin E2 (PGE2) 34–37. Several mechanical devices have been evaluated for priming and IOL, of which transcervical balloons such as the Foley catheter balloon (FCB) are the most widely used 38–40.…”

Labor and Delivery Outcomes with the Sequential Use of Misoprostol Followed by Cervical Foley Catheter

“…These include prostaglandins such as misoprostol and mechanical agents such as the Foley catheter. [2][3][4][5][6] Previous studies have examined the efficacy of simultaneous use of misoprostol and cervical Foley catheter. These studies demonstrate that concurrent use of misoprostol and cervical Foley catheter reduces time to delivery among women undergoing an IOL compared with single agent methods, although cesarean delivery (CD) rates are similar between the groups.…”