Evaluation of non-pharmacological method-transcervical foley catheter to intravaginal misoprostol and Prostaglandin E2 gel for preinduction cervical ripening

The efficacy of intracervical Foley catheter with misoprostol (PGE1) and dinoprostone (PGE2) for preinduction cervical ripening, induction of labour, mode of delivery, induction to delivery interval and maternal complications has been compared.. Women who were admitted to hospital and met criteria for entrance in the trial were counseled and enrolled after informed consent. Inclusion criteria included full term singleton gestation, cephalic presentation, with one or more of the common indication for induction of labour including post-term pregnancy, preeclampsia, oligohydramnios etc. Bishop score <6 was necessary criteria for entry. Exclusion criteria included rupture of membranes, antepartum bleeding, placenta praevia, previous induction or preinduction agent during the pregnancy. Each woman was assigned to receive cervical ripening with a transcervical Foley catheter or misoprostol or dinoprostone, by selection of the next consecutive envelope. The group assigned misoprostol had 25 g of misoprostol placed intravaginally in post fornix, every 4 hours for a maximum 8 doses.The women assigned to the disoprostone group, received a maximum of 3 doses of vaginal gel, each containing 2 mg of dinoprostone in their post fornix once every 6 hours.In both these groups subsequent doses were withhold if regular uterine contraction was established (at least 1 in 10 minutes regularly), tachysystole (6 contraction in 10 minutes), uterine hyperstimulation or nonreassuring FHR or rupture of membranes occurred. Oxytocin was begun 4 hours after the last dose of misoprostol or dinoprostone in women who did not have spontaneous labour (regular contraction with continued cervical change). All the women underwent cardiotocography 20 minutes after administration of the medication or insertion of the catheter. Primary outcomes included change in Bishop score. Secondary outcome measures included total time for induction, delivery route, uterine tachysystole, uterine hypertonus, subject comfort. A total of 160 women were enrolled in the study. Two were excluded because of deviation from entry criteria. So of the 156 subjects, 50 were assigned to treatment with Foley Catheter, 54 with Misoprostol and 52 with Dinoprostone. The shortest mean induction to delivery was obtained with catheter (19.18h) as compared to Dinoprostone (20.12hr) and Misoprostol (21.04hr). The cervical Ripening with Foley catheter is the safe method for labour induction. Induction with Misoprostol and Dinoprostone is equally effective and safe.