Cervical ripening and induction of labour: Inpatient or outpatient, oral misoprostol or Foley catheter? (original) (raw)
Related papers
Cervical Ripening and Labor Induction: A Current Review
Journal of the Islamic Medical Association of North America, 2007
Labor induction Is often necessary because of maternal ar fetallndlcatlons. When performed with an unripe cervix, it results in prolonged labor, potential medical compliad:ions, and an increased rate of cesarean seclio:o. The purpose of cervk:aI ripening and induction of Iabar Is to achieve vaginal delivery and avoid operative delivery by cesarean section. In this revlew, we present cellular and biochemical events in cervk:aI ripeJling and discuss the indications and contralndlcatlons of labor l!IductIolI, and then describe various pharmacologic and mechanical methods for ripening the cerv:Ix and inducing labor.
Bangladesh Journal of Obstetrics & Gynaecology, 2016
Many women who undergo labor induction do not have a favorable cervix, which can lead to a prolonged and difficult induction, so some method of cervical ripening-pharmaceutical or mechanical-often is used 1,2. Pre-induction cervical ripening is often done to increase the likelihood of successful labour induction 3-5 More than 15% of pregnant women need pre-induction cervical ripening before labour induction 6. So there is a keen interest in developing safer, more cost effective and more efficient means of pre-induction cervical ripening. Rates of labor induction in the United States rose from 9.5% to 23.2% of all deliveries between 1990 and 2010. 7,8 Although labor is usually induced for maternal or fetal indications, inductions without maternal or fetal indication, or elective inductions, recently have been on the rise 9,10 .
Sri Lanka Journal of Obstetrics and Gynaecology, 2014
Introduction: An intracervical Foley catheter is a common method used for pre-induction cervical ripening in Sri Lanka. Low dose oral Misoprostol (25 µg 2 hrly) has been recently recommended as a method for ripening of cervix and induction of labour (IOL) Objectives: To compare the effectiveness of the insertion of an intra-cervical Foley catheter for 24 hrs versus two doses of oral Misoprostol-25µg four hours apart, in ripening the cervix prior to IOL, in postdated pregnancies. Methods: A Randomized controlled trial. Women with uncomplicated singleton pregnancies, having a cephalic presentation and a cervix unfavorable for IOL [modified Bishop Score (MBS) < 6] at 40 weeks and 6 days of gestation, were allocated to receive either two doses of oral Misoprostol-25 µg, four hours apart (n=74) or intracervical Foley Catheter for 24 hrs (n=78), by stratified (primip / multip) block randomization. The following morning all were assessed and their MBS recorded by one of the last three authors, all of whom were blind to the interventions, as other doctors supervised and carried out the interventions. If the cervix was favourable, IOL was carried out with amniotomy and intravenous oxytocin infusion. The method of delivery and induction delivery interval (IDI) were recorded. If spontaneous labour (SOL) was established prior to this assessment, it was recorded. Results: There were no significant differences in the distribution of parity, and the mean ages and the mean pre intervention MBS in the primigravidae and multigravidae, between the two study groups. There were significant increases in mean MBS (ranging from 2.6-3.3 and 95% CIs 1.7-4.1, p <0.001) after the interventions in both groups. However there was no significant difference between the mean increases of MBS between the groups. In the primigravidae, the mean MBS after 24 hours was greater in the Foley catheter group compared to the misoprostol group (6.9, 95%CI 6.3-7.5 vs 5.7, 95% CI 4.8-6.7, p < 0.05). There were no significant differences in the proportions of primips and multips establishing SOL. More primips and multips had cervices favourable for IOL in the Foley catheter group compared to the misoprostol group (p < 0.05). There were no significant differences in the mean IDI after IOL; successful vaginal delivery after IOL; and the caesarean section rates between the groups. In the Misoprostol group there were no cases of uterine hyperstimulation, but two women complained of dyspepsia. Conclusions: Intracervical Foley catheter for 24 hours was better than two doses of 25 µg misoprostol administered orally four hours apart, for pre induction cervical ripening in postdated pregnancies.
Comparison of Vaginal Misoprostol with Foley Catheter for Cervical Ripening and Induction of Labor
Iranian Journal of Pharmaceutical Research : IJPR, 2011
At times, despite an unripe cervix, induction of labor may be needed. In these cases, a safe and suitable method should be considered for cervical ripening and pregnancy termination. The aim of this study is the comparison of vaginal misoprostol with Foley catheter for cervical ripening and induction of labor. This randomized clinical trial was performed on 108 pregnant women who had referred to the teaching hospitals of Mashhad University of Medical Sciences during a time period of September 2007 to March 2008. These women were randomly divided into two groups: Misoprostol (including 49 patients) and Foley catheter (including 59 patients). For the first group, 25 microgram vaginal misoprostol was administered every 4 h up to maximum 6 doses. For the second group, Foley catheter 18 F, inflated with 50 cc of sterile water, was placed through the internal os of the cervix. Data was analyzed using SPSS software. p < 0.05 was considered statistically significant. Two groups were simi...
Paediatric and Perinatal Epidemiology, 2019
Background: There is no consensus about the ideal cervical ripening method to use for induction of labour. Objective: To compare in current practice the effectiveness and safety of four cervical ripening methods. Methods: We performed a matched comparative study using data from the MEDIP prospective population-based cohort conducted during one month in 2015 in all maternity units of seven French perinatal networks (3042 consecutive women with a live fetus and induction of labour). We analysed 1671 women with singleton cephalic fetus, unscarred uterus, and bishop score <7. Dinoprostone vaginal pessary (reference) was compared to dinoprostone vaginal gel, misoprostol vaginal tablet, and balloon catheter. Effectiveness outcomes were the need for more than one induction agent, oxytocin use, failure to achieve vaginal delivery within 24 hours (VD < 24 hours), and caesarean delivery. Safety outcomes were meconium-stained amniotic fluid, uterine hyperstimulation, NICU admission, and post-partum haemorrhage. Coarsened exact matching was used to balance confounders among the groups. Outcomes were compared using multivariable logistic regression models. Results: Compared to the dinoprostone pessary (N = 1142, 68.3%), dinoprostone gel (N = 335, 20.1%) was associated with less failure to achieve VD < 24 hours (adjusted OR 0.66, 95% CI 0.47, 0.91). Misoprostol (N = 103, 6.2%) was associated with less need of more than one induction agent (aOR 0.56, 95% CI 0.34, 0.92) and less oxytocin use (aOR 0.60, 95% CI 0.37, 0.99). The balloon catheter (N = 91, 5.4%) was associated with more failure to achieve VD < 24 hours (aOR 2.62, 95% CI 1.37, 5.01), more caesarean delivery (aOR 1.84, 95% CI 1.09, 3.08), and less meconium-stained amniotic fluid (aOR 0.12, 95% CI 0.02, 0.70). Uterine hyperstimulation rates seemed lower with the balloon catheter (1.2% vs 4.2% for the pessary). Conclusions: In current practice, no cervical ripening method appears clearly superior to the others considering all effectiveness and safety outcomes.
Background Induction of labor is defined as iatrogenic stimulation of uterine contractions to cause the delivery of fetus before the onset of spontaneous labour. An unfavorable cervix is a critical factor the obstetrician must overcome to improve the efficacy of induction of labor. At present, both medical and mechanical methods have been applied for cervical ripening in women with an unfavorable cervix. In developing countries like Ethiopia, conventionally cheap and feasible method used for preinduction cervical ripening is transcervical Foley’s catheter and misoprostol become practically important. So this study is designed to investigate the effectiveness of the most commonly ripening techniques (Foley catheter and vaginal misoprostol) in Gedeo zone. Method This is a quasi-experimental study to compare the effectiveness of Foley catheter and vaginal misoprostol for cervical ripening for labor induction. It was conducted in 120 pregnant mothers coming for induction who fulfil the ...
Mechanical Cervical Ripening with Foley Catheter Balloon: Rekindling a Forgotten Art
Journal of SAFOG, 2018
Introduction: Induction of labor is carried out in 20% of pregnancies in some countries. The success of induction of labor depends mainly upon the cervical ripening score. The most popularly used prostaglandins, misoprostol and dinoprostone, are effective in cervical ripening but have side effects of uterine hyperstimulation and fetal hypoxia, which may increase operative intervention and admissions to neonatal intensive care units. Mechanical dilatation is an age-old method that is safe and effective but lost its popularity with fear of chorioamnionitis. Aims and objectives: To study the efficacy and safety of Foley's catheter balloon as cervical ripening method when compared with misoprostol administered vaginally. Materials and methods: In this experimental study, 50 full-term patients with poor cervical score were included. They were divided into group I-those who received intracervical Foley and group II-those who received vaginal misoprostol. The cervical score was reassessed 24 hours later. Other variables like mode of delivery, fetal heart variability, and uterine hyperstimulation were also studied. Results: Both groups I and II showed improvement in cervical score. The occurrence of uterine hyperstimulation and fetal heart variabilities was less in group I. Conclusion: Mechanical cervical ripening with Foley's balloon catheter is as effective and safer compared with msoprostol when used for preinduction cervical ripening in full-term patients.
https://www.ijrrjournal.com/IJRR\_Vol.9\_Issue.1\_Jan2022/IJRR-Abstract039.html, 2022
Background: Cervical ripening essentially refers to the process of softening the cervix in order to make it prepare for the induction of labor. The success of labor induction depends on the cervical status at the time of induction. There are various methods of cervical ripening; however, in this study we will compare two famous methods of cervical ripening; Foley's cervical catheter and PGE2gel. Method: This prospective study was conducted at Lala-Ded Hospital, Srinagar from March 2016-September 2017. A total of 70 women fulfilling the defined inclusion criteria were enrolled for this study. They were randomly distributed into 2 groups, Group 1 (Foley's catheter group) and Group 2 (PGE2 gel group) with 35 women included in each group. Patients at term with various indications for induction of labor were included in the study after a comprehensive written consent. Result: The age distribution between the groups was insignificant. We observed that average gestational age was comparable in both the groups with a p-value of 0.526. However, the average post induction Bishop's score was significantly higher in group 1 compared to group 2with a p-value of 0.034. Conclusion: The present study demonstrated that even though both the methods of cervical ripening are effective but with Foley's intracervical catheter we witnessed a shorter induction delivery interval in comparison to PGE2 gel. Moreover, there was significant improvement in Bishop's score with Foley's catheter. Therefore, we suggest that in developing countries with limited resources Foley catheter is the optimal choice for pre induction cervical ripening in terms of cost effectiveness and attaining the desired results.