Foley’s Catheter and Vaginal Misoprostol vs Vaginal Misoprostol Alone for Labor Induction

Abstract

Objectives: To compare the efficacy of transcervical Foley’s catheter and vaginal misoprostol vs vaginal misoprostol alone in the induction of labor at or after 39 weeks of gestation. Methods: This randomized comparative study included 110 women with a singleton gestation, vertex presentation, gestation>39 weeks, Bishop’s score <6, and no contraindication for normal vaginal delivery. General examination, systemic examination, obstetric examination, and pelvic examination were done to note the Bishop’s score and adequacy of pelvis, and the patients were grouped in two categories: Group A: Tablet Misoprostol 25 μg and Group B: Tablet Misoprostol 25 μg plus Foley’s catheter (No. 16). Results: Mean ± SD of induction to delivery interval (hours) in group B (14.6 ± 2.26) was significantly lesser as compared to group A (17.9 ± 2.82) (p value 0.05). The intrapartum complications were comparable between groups A and B (fever, diarrhea, tachysystole, hypertonic contraction, hyperstimulation syndrome, p = 0.495). The postpartum complications were comparable between groups A and B (atonic PPH, traumatic PPH: p >0.05). The abnormal heart rate (bradycardia: 3.64% vs 5.45%, p = 1 and persistent tachycardia: 3.64% vs 1.82%, p = 1) and presence of meconium-stained liquor (7.27% vs 5.45%, p = 1) were comparable between groups A and B. Group A and B had comparable neonatal outcomes [NICU admission, reason for NICU admission, early neonatal death, mean Apgar at 1 minute (7.8 vs 7.85, p = 0.524), and Apgar at 5 minutes (8.85 vs 8.95, p = 0.242)]. Conclusion: To conclude, the combination of Foley’s catheter + vaginal misoprostol resulted in significant improvement in Bishop score and shorter induction to delivery interval than vaginal misoprostol alone. Thus, it is more preferable to use a combination of vaginal misoprostol and Foley’s catheter for induction of labor. However, both techniques were equally effective in terms of mode of delivery, indication for cesarean section, intrapartum and postpartum complications, abnormal heart rate, meconium-stained liquor, and neonatal outcomes.