Cervical Ripening for Induction of Labor: A Randomized Comparison between Vaginal Misoprostol versus Foley’s Catheter Placement in a Nigeria Tertiary Hospital

Introduction: Induction of labor is done with the aim of normal vaginal delivery. There are different methods; mechanical like intra-cervical Foley’s or pharmacological agents like misoprostol ordinoprostone. Objectives: To compare sequential use of Foley’s catheter and vaginal misoprostol in comparison with vaginal misoprostol only. Methods: Patients with period of gestation more than or equal to 41 weeks without any complications were assigned randomly according to computer generated randomization into sequential use ofintracervical Foley followed by vaginal misoprostol after 24 hours (sequential group) or vaginalmisoprostol only. Primary outcome was rate of normal vaginal delivery. Secondary outcomes were induction to delivery interval, maternal and fetal morbidity. Results: Rate of normal vaginal delivery in sequential group (n= 353) and misoprostol alone group(n= 356) was 71.6% and 53.3% (p < 0.001) but the time to delivery from induction is statistically more in sequential group (30.3 vs. 11.2 hours, p< 0.001). Maternal outcomes like postpartum hemorrhage, hyper-stimulation syndrome, chorioamnitis and neonatal outcomes like low Apgar score, meconium stained baby and stillbirth are similar in both the groups. Conclusions: The priming of cervix using intracervical Foley catheter before giving vaginalmisoprostol was beneficial in increasing the rate of normal vaginal delivery but it increased the induction to delivery interval.

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Efficacy of vaginal Misoprostol versus transcervical Foley’s catheter and vaginal Misoprostol in induction of labor

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190982 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1341

Author(s):

Vijayalaxmi Davalagi ◽

Lakshmikantha G. ◽

Neeta .

Keyword(s):

Induction Of Labor ◽

Comparative Efficacy ◽

Catheter Group ◽

Misoprostol Group ◽

The Common ◽

Vaginal Misoprostol ◽

Foley’S Catheter ◽

Labour Room ◽

A Prospective Study ◽

Failure Of Induction

Background: The objective is to compare the efficacy of vaginal Misoprostol versus transcervical Foley’s catheter and vaginal Misoprostol.Methods: A prospective study analyzing the comparative efficacy of intravaginal instillation of Misoprostol in two groups (tablet Misoprostol 50mg alone and combination of intracervical Foley’s catheter and tablet Misoprostol 50mg) carried out in the labour room on 300 subjects (150 subjects in each group), from May 2013 to November 2015.Results: The common gestational age at the time of induction was 36-40 weeks and the most common indication was premature rupture of membrane. In both the groups, most of the cases delivered within 12 hours. present results show that statistically significant number of cases delivered vaginally within 12 hours with the group using Misoprostol plus Foley’s catheter as compared to the group using Misoprostol alone. Cesarean section rate was 12.67% in Misoprostol group and 10.67% in Misoprostol plus Foley’s catheter group. Incidence of failure of induction was similar in both the groups. The incidence of babies with Apgar score less than 8/10 at 5 minutes and incidence of early neonatal death were similar in both the groups.Conclusions: Addition of intracervical Foley’s catheter to vaginal Misoprostol for induction of labor in subjects with unfavorable cervices reduces the Induction-Delivery interval without added side effects or complications to the mother and fetus.

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Titrated oral misoprostol solution versus vaginal misoprostol for labor induction in primi gravid ladies

QJM ◽

10.1093/qjmed/hcaa056.010 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

I M Abdalfattah ◽

W E Mohammed ◽

A A El-gaml

Keyword(s):

Safety Profile ◽

Tap Water ◽

Maternity Hospital ◽

Labor Induction ◽

Induction Of Labor ◽

Cervical Ripening ◽

Controlled Clinical Trial ◽

Solution Versus ◽

Oral Misoprostol ◽

Vaginal Misoprostol

Abstract Background It is now generally accepted that the uterine cervix plays an important role during pregnancy and labor and that it depends on an active ripening process within the cervix; which is necessary for successful labor induction. Aim of the Work to test the safety and efficacy of titrated oral misoprostol compared to vaginal misoprostol for labor induction in term gravid ladies. Patients and Methods This prospective, single-blinded randomized controlled clinical trial was conducted at Ain-Shams University Maternity Hospital during the period between August 2017 and August 2018. 120 pregnant women planned for induction of labor were recruited in the study according to the inclusion / exclusion criteria. Subjects included in the study were randomized into two groups: patients who received oral 200 ug misoprostol in 200 ml water titrated over 24 hours and placebo tablets vaginally which resemble vagiprost tablets (25 microgram misoprostol) and the second group contained pients who received vaginal misoprostol 25microg maximum four doses, and placebo solution of 200 ml of tap water. Results titrated oral misoprostol is as effective in promoting cervical ripening and inducing labor as intravaginal misoprostol, oral Misoprostol has a similar maternal and perinatal safety profile to vaginal misoprostol. Conclusion This new approach to oral misoprostol administration was successful in minimizing the risk of uterine hyper-stimulation, which has been a feature of misoprostol use for induction of labor, at the expense of a somewhat slower response. Oral Misoprostol has a similar maternal and perinatal safety profile compared to vaginal misoprostol.

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Efficacy of misoprostol over dinoprostone gel as a cervical ripening agent: a comparative study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175060 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5251 ◽

Cited By ~ 1

Author(s):

Pankajkumar B. Nimbalkar ◽

Jaldhara N. Patel ◽

Nilesh Thakor

Keyword(s):

Age Groups ◽

Induction Of Labor ◽

Cervical Ripening ◽

Healthy Baby ◽

Mortality And Morbidity ◽

Medical College ◽

Maternal Mortality And Morbidity ◽

Misoprostol Group ◽

Vaginal Misoprostol ◽

Age Range

Background: Timely induction of labour could reduce maternal mortality and morbidity as well as assure a delivery of healthy baby. The objective of this study was to evaluate the efficacy of Misoprostol as a cervical ripening agent and its comparison with Dinoprostone gel in terms of success rate, safety, side effects and patient compliance.Methods: A total of 250 pregnant women requiring induction of labor were recruited. Out of 250 cases, 150 were induced with 50 microgram Misoprostol and 100 cases with 0.5 mg intracervical Dinoprostone gel during September 2014 to August 2017 at the department of Obstetrics and Gynaecology, GMERS Medical College, Dharpur-Patan. Written and informed consent was taken from the patients. Outcome measures, such as change in Bishop's score, need of augmentation, induction delivery interval; complications like hyperstimulation, fever and meconium passage were compared between two groups. Statistical analysis was performed by Epi Info 7.Results: Age range of the patients was 21 to 35 years. 74.8% of the patients were in 21-25 years age groups. 50.4% patients were multigravida. 57.6% patients had more than 37 weeks of pregnancy. 50.4% of the patients had premature rupture of membrane as indication of labour. The mean Bishop's score for induction was 3.21 in Misoprostol group. 81.3% patients in Misoprostol group and 93% of patients in Dinoprostone group were delivered by vaginal delivery. 60% patients delivered within 6 hours in Misoprostol group. (Misoprostol: 60%, Dinoprostone: 27%, p<0.001). Incidence of thin meconium was 11.3% in Misoprostol group, 9% in Dinoprostone group. In Misoprostol group 3.3 women had fever after induction.Conclusions: Vaginal misoprostol is more efficacious in cervical ripening and for induction of labor than Dinoprostone.

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Combined Foley's catheter with vaginal misoprostol for pre-induction cervical ripening: A randomised controlled trial

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/ajo.12562 ◽

2017 ◽

Vol 57 (1) ◽

pp. 119-119 ◽

Cited By ~ 1

Author(s):

Olusola Peter Aduloju ◽

Akinyemi Akinsoji Akintayo

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Cervical Ripening ◽

Vaginal Misoprostol ◽

Foley’S Catheter ◽

Randomised Controlled

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Comparing the effects of vaginal misoprostol, laminaria, and extra amniotic saline infusion on cervical ripening and induction of labor

Obstetrics & Gynecology Science ◽

10.5468/ogs.2020.63.3.261 ◽

2020 ◽

Vol 63 (3) ◽

pp. 261-269

Author(s):

Zohreh Tabasi ◽

Elaheh Mesdaghinia ◽

Masoumeh Abedzadeh-Kalahroudi ◽

Mojtaba Sehat ◽

Aida Panahandeh

Keyword(s):

Induction Of Labor ◽

Saline Infusion ◽

Cervical Ripening ◽

Vaginal Misoprostol

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Comparison of low dose vaginal misoprostol with Foley catheter balloon as preinduction cervical ripening agents in term pregnancies

Annals of Medical Research and Practice ◽

10.25259/anmrp_3_2020 ◽

2020 ◽

Vol 1 ◽

pp. 10

Author(s):

Dalyop Davou Nyango ◽

Daloek M ◽

Kahansim ML

Keyword(s):

Pregnant Women ◽

Low Dose ◽

Foley Catheter ◽

Comparative Trial ◽

Tertiary Hospital ◽

Cervical Ripening ◽

Catheter Group ◽

Misoprostol Group ◽

Uterine Hyperstimulation ◽

Vaginal Misoprostol

Objective: One of the obstetricians’ nightmare is managing high-risk pregnancies. Also, the emerging trend by pregnant women requesting for specific delivery dates for social reasons adds to this burden. In both instances, the obstetrician is faced with the challenge of inducing labor where the cervix is still unfavorable. The objective of the study was to compare the effectiveness of loe dose vaginal misoprostol and transcervical extra-amniotic Foley catheter balloon as pre-induction cervical ripening agents in term pregnancies. Material and Methods: This was a prospective, single-blind, randomized comparative trial at a tertiary hospital. Pregnant women at term in whom induction of labor was indicated, who made the inclusion criteria and who gave their consent were randomly assigned to either the vaginal misoprostol or the Foley catheter balloon group. Oxytocin was used for the augmentation of labor subsequent to the artificial rupture of the membranes according to the departmental protocols. Results: One hundred and fifty women were recruited and randomized (75 in each group). In the misoprostol group, 58 (77.3%) women achieved cervical ripening (cervical dilation of ≥4) within 12 h, compared to 43 (57.3%) in the Foley catheter balloon group. Spontaneous vaginal delivery within 12 h was 88.0% and 66.3% in the misoprostol and Foley catheter group, respectively. However, 34.7% in misoprostol group had precipitate labor (induction-to-delivery interval ≤3 h), while 9.3% in the Foley catheter group had prolonged labor. There were no significant differences in the incidence of meconium staining and 1st min Apgar scores of the babies in the two groups. Conclusion: Low dose (25 μg) vaginal misoprostol is a more effective pre-induction cervical ripening agent compared to the conventional transcervical extra-amniotic Foley catheter balloon method. While uterine hyperstimulation is the major risk in the misoprostol group, long induction-to-delivery interval is associated with labors induced following use of Foley catheter balloon as the pre-induction cervical ripening agent.

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Intravenous Dexamethasone Versus Vaginal Misoprostol in Enhancing Cervical Ripening and Labor Induction

QJM ◽

10.1093/qjmed/hcab115.021 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Mahmoud Salman ◽

Fekria Ahmed Salama ◽

Mina Yacoub

Keyword(s):

Total Duration ◽

Active Phase ◽

Labor Induction ◽

Induction Of Labor ◽

Cervical Ripening ◽

Control Group ◽

P Value ◽

Time Interval ◽

Vaginal Misoprostol ◽

Mean Time

Abstract Background Induction of labor is one of the most common procedures performed in the world of Obstetrics. Traditionally, labor induction is performed using prostaglandin and oxytocin. However, usage of corticosteroids nowadays is gaining a lot of interest regarding its effects on cervical ripening and shortening the physiological process of labor. Aim of work to evaluate the efficacy of intravenous dexamethasone versus vaginal misoprostol in enhancing cervical ripening and labor induction. Patients and Methods A randomized controlled clinical trial was carried out at Ain Shams University Maternity Hospital on (60) full term pregnant women between 39 – 42 weeks undergoing induction of labor, during a period from April 01, 2019 to November 30, 2019. Pregnant women were divided into two groups; vaginal misoprostol (control) group and intravenous dexamethasone (experimental) group (30 cases each). Results Our study showed that the mean time interval (hours) from initiation of labor induction to initiation of active phase was statistically significantly shorter among the dexamethasone (experimental) group 7.36 ± 2.23 versus 12.20 ± 4.92 hours among the vaginal misoprostol (control) group (p value < 0.001). Also, the mean time interval of the total duration between the induction of labor to successful vaginal delivery was statistically significantly shorter among the dexamethasone group 10.90 ± 4.17 versus 19.20 ± 5.62 hours among the vaginal misoprostol group (p value < 0.001). The results of this study showed the rate of initiation of active phase and rate of successful vaginal delivery were more in the experimental dexamethasone group than the control vaginal misoprostol control group. Conclusion Intravenous injection of 8 mg of dexamethasone before induction of labor is found to shorten the duration of labor induction by reducing the time interval between the initiation of labor induction and onset of active phase and the total duration from initiation of labor induction to delivery with no marked maternal or fetal complications. Recommendations Intravenous Dexamethasone can help cervical ripening and accelerate induction of labor. Further research should be taken in consideration with more population for more global evaluation.

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