A comparative study of vaginal misoprostol, dinoprostone gel, foley catheter, extra amniotic saline infusion along with vaginal misoprostol for induction of labor at term


  • Ektha M. Shetty Department of Obstetrics and Gynecology, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka, India http://orcid.org/0000-0003-3591-9124
  • Asha Neravi Department of Obstetrics and Gynecology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India




Bishop score, Dinoprostone gel, Extra amniotic saline infusion, Foley catheter, Induction of labor, Misoprostol


Background: Objective of this study was to study the effect of vaginal misoprostol, dinoprostone gel, foley catheter, extra amniotic saline infusion along with vaginal misoprostol for induction of labor at term on maternal and fetal outcome.

Methods: A one-year prospective observational study was conducted in the department of obstetrics and gynecology, SDM College of Medical Science and Hospital, Dharwad. Totally 100 postdated primigravida women with singleton gestation, vertex presentation and intact membrane who were induced with any four methods of induction 1) Tab. misoprostol 25 µg vaginally, 2) Intracervical dinoprostone gel, 3) Foley catheter and 4) Extra amniotic saline infusion along with tab. misoprostol 25 µg vaginally with 25 patients selected in each group, by random allocation technique and included in the study. Outcome measures analysed were the demographic profile, bishop score, induction to delivery interval, mode of delivery, maternal and fetal complications. Statistical analysis was done using SPSS 17 software.

Results: Mean induction delivery interval was significant between PGE1 versus foley group (p=0.0034). In this study, 60% patients in dinoprostone group had Vaginal delivery and 72% in the EASI + misoprostol group underwent cesarean section (p=0.0372). NICU admission was maximum with EASI + vaginal misoprostol group and minimum with vaginal misoprostol alone.

Conclusions: The groups were comparable with respect to maternal age, bishop score and fetal weight. The vaginal misoprostol group had shortest induction delivery interval. The maximum number of patients in dinoprostone gel group underwent vaginal delivery with a highest cesarean section and NICU admission with the EASI + misoprostol group.


De Ribes C. De l'Accouchementrovoque, Dilatation du Canal Genital a l'Aide deBallons Introduitsdans la Cavite Uterine Pendant la Grossesse. Paris, Steinheil; 1988.

Cunningham, Gary F, editor. Williams Obsterics. 24th edition, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, et al, New York: McGraw-Hill Education/Medical; 2014.

Eden TW. Review: a manual of midwifery, 3rd ed. Lancet. 1912;1:1064.

Page EW. Response of human pregnant uterus to pitocintannate in oil. Proc Soc Exp Biol. 1943;52:195-7.

Karim SMM, Trussele RR, Patel RC, Hillier K. Response of pregnant human uterus to prostaglandin F2 alpha induction of labour. BMJ. 1968;IV:621-3.

Keirse MJNC. Prostaglandins in pre-induction cervical ripening. Meta-analysis of world-wide clinical experience. J Reprod Med. 1993;38(Suppl):69-98.

Wing DA. Misoprostol vaginal insert compared with dinoprostone vaginal insert: a randomized controlled trial. Obstet Gynecol. 2008;112(4):801-12.

Atad J, Bornstein J, Calderon I, Petrikovsky BM, Sorokin Y, Abramovici H. Nonpharmaceutical ripening of the unfavorable cervix and induction of labor by a novel double balloon device. ObstetGynecol. 1991;77:146-52.

Roudsari FV, Ayati S, Ghasemi M, Mofrad MH, Shakeri MT, Farshidi F, et al. Comparison of vaginal misoprostol with foley catheter for cervical ripening and induction of labor. Iran J Pharm Res. 2011;10(1):149-54.

Calder AA, Embrey MP, Tait T. Ripening of the cervix with extra-amniotic PGE2 in viscous gel before induction of labor. Br J Obstet Gynaecol. 1977;84:264-8.

Reinhard J, Raddatz R, Langer R, Fessler S, Kaufmann C, Nteli VA, et al. Pilot study. Mechanical versus pharmacological term induction: a cohort group analysis of maternal and neonatal outcome-hygroscopic cervical dilator versus prostaglandin E2. Clin Obstet Gynecol Reprod Med. 2016;2.

Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M. Mechanical methods for induction of labour. Cochrane Database of Syst Rev. 2012;3:Art.No:CD001233.






Original Research Articles