Intravaginal misoprostol versus Foley catheter for labour induction: a meta-analysis

Abstract

Background There are a number of agents used for cervical ripening prior to the induction of labour. Two commonly used agents are intravaginal misoprostol and a transcervical Foley catheter.Objective To review the evidence comparing misoprostol and transcervical Foley catheter placement for induction of labour, and perform a meta-analysis comparing these two induction agents.Search strategy We conducted database searches of PubMed, Embase, the Cochrane Library Database, and the ClinicalTrials.gov website. Bibliographies of all relevant articles were reviewed.Selection criteria Prospective, randomised trials comparing the use of intravaginal misoprostol and transcervical Foley catheter for the purpose of cervical ripening and induction of labour were included. We excluded studies in which the patients in these two intervention groups also received other induction agents concurrently, such as oral misoprostol, oxytocin, or other prostaglandins.Data collection and analysis The primary outcomes selected were time to delivery, and the rates of caesarean section, uterine tachysystole, and chorioamnionitis. Random-effects generalised linear models with a poisson distribution and log link function were used to compare the two induction agents across the studies.Main results Nine studies (1603 patients) were identified as eligible to be included in this meta-analysis. There were no significant differences in the mean time to delivery (mean difference 1.08 ± 2.19 hours shorter for misoprostol, P = 0.2348), the rate of caesarean delivery (RR 0.991; 95% CI 0.768, 1.278), or in the rate of chorioamnionitis (RR 1.130; 95% CI 0.611, 2.089) between women who received misoprostol compared with transcervical Foley catheter. Patients who received misoprostol had significantly higher rates of tachysystole compared with women who received a transcervical Foley catheter (RR 2.844; 95% CI 1.392, 5.812).Conclusions Intravaginal misoprostol and transcervical Foley catheter have similar effectiveness as induction agents. Transcervical Foley catheter is associated with a lower incidence of tachysystole.

Misoprostol versus prostaglandin E2 gel for labor induction in premature rupture of membranes after 34 weeks of pregnancy

“…Similar results are found for the comparison of Foley catheter versus misoprostol for labor induction [16]. Therefore, prostaglandin E2 gel is more appropriate for labor induction Vaginal PGE2 gel at 0.5 mg every 6 hours (maximum two doses)…”

Labor Induction in Late-Onset Fetal Growth Restriction: Foley Balloon versus Vaginal Dinoprostone

“…It has been observed that the placement of an intracervical Foley balloon can stimulate local production of prostaglandins, initiating cervical priming without associating excessive uterine contractions [23]. Furthermore, it has been linked to a lower rate of uterine tachysystole both during labor induction and the active labor phase [24]. We have also observed that Foley balloon is associated with a lower rate of uterine tachysystole and abnormal CTG both during the cervical ripening process and during labor as a whole, and this could explain the overall lower cesarean section rate obtained with this method.…”

“…The evidence on FGR is even scarcer. Recently, the Foley catheter has been proposed as the optimal method in FGR given that cervical ripening with this method is associated with less uterine stimulation with a lower risk of tachysystole than with prostaglandins [10]. …”

Geburtseinleitung: „anything new?“

“…Die Gabe von intrazervikalem oder vaginalem PGE2-Gel sowie die anschließende Weheninduktion mit Oxytocin ist nach Aufklärung der Patientin über das erhöh-te Risiko einer Uterusruptur vertretbar [26]. [32].…”