Efficacy and safety of intracervical Foley’s in women receiving sublingual misoprostol for induction of labour: a randomized controlled trial

Authors

  • Salini Yadaraju Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, Puducherry, India
  • Latha Chaturvedula Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, Puducherry, India
  • Sasirekha Rengaraj Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, Puducherry, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204301

Keywords:

Induction of labour, Intracervical Foley’s, Misoprostol, Sublingual

Abstract

Background: Induction of labour can be carried out by medical or mechanical methods, used alone or in combination. This study is to evaluate the efficacy and safety of intracervical Foley’s in women receiving sublingual misoprostol for induction of labour.

Methods: We randomized 230 primi gravidae at ≥37 weeks of gestation, with singleton pregnancy, cephalic presentation requiring induction, with Bishop score ≤4 using block randomization into study and control groups. Both groups received 50 µg sublingual misoprostol every fourth hourly till active labour was achieved or upto a maximum of 6 doses. The study group was induced simultaneously with intracervical Foley catheter.

Results: Mean induction to labour interval in study and control groups was 11.191±7.14 hours and 11.758±6.26 hours while mean induction to delivery interval was 17.502±7.93 hours and 18.275±7.66 hours respectively with no significant difference between the groups (p=0.522 and 0.453). More women in study group than in the control (51.3% versus 33.9%) were in active labour within ten hours of induction (p=0.001). Caesarean section rate was 23.5% and 19.1% in study and control groups (p=0.497), the most common indication being foetal distress. Secondary outcomes like foetal heart rate abnormalities, oxytocin requirement were comparable between the two groups. APGAR scores and NICU admission rate were similar in both groups. There was no significant maternal or neonatal morbidity.

Conclusions: Though there was no significant reduction in induction to labour or delivery interval with synchronous use of sublingual misoprostol and Foley’s, there was no increase in the complications encountered.

References

WHO Recommendations for Induction of Labour. Geneva: World Health Organization; 2011. Available at: http://www.ncbi.nlm.nih.gov/books/ NBK131963/. Accessed on 14 March 2015.

ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009;114(2 Pt 1):386-97.

Vogel JP, Souza JP, Gülmezoglu AM. Patterns and outcomes of induction of labour in Africa and Asia: a secondary analysis of the WHO global survey on maternal and neonatal health. PLoS One. 2013;8(6):e65612.

Stock SJ, Ferguson E, Duffy A, Ford I, Chalmers J, Norman JE. Outcomes of elective induction of labour compared with expectant management: population based study. BMJ. 2012;344:e2838.

Davey MA, King J. Caesarean section following induction of labour in uncomplicated first births- a population-based cross-sectional analysis of 42,950 births. BMC Pregnancy Childbirth. 2016;16:92.

Gupta S, Shekhavath U, Premlata M, Madhu M. To study the fetomaternal outcome and progress of labour among induced versus spontaneous labour in nulliparous women (Using WHO partograph). Sch J App Med Sci. 2014;2(5A):1577-80.

Kaul B, Vallejo MC, Ramanathan S, Mandell G, Phelps AL, Daftary AR. Induction of labor with oxytocin increases cesarean section rate as compared with oxytocin for augmentation of spontaneous labor in nulliparous parturients controlled for lumbar epidural analgesia. J Clin Anesth. 2004;16(6):411-4.

Carbone JF, Tuuli MG, Fogertey PJ, Roehl KA, Macones GA. Combination of Foley bulb and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and labor induction: a randomized controlled trial. Obstet Gynecol. 2013;121(2 Pt 1):247-52.

Hill JB, Thigpen BD, Bofill JA, Magann E, Moore LE, Martin JN. A randomized clinical trial comparing vaginal misoprostol versus cervical Foley plus oral misoprostol for cervical ripening and labor induction. Am J Perinatol. 2009;26(1):33-8.

Aduloju OP, Akintayo AA, Adanikin AI, Ade-ojo IP. Combined Foley's catheter with vaginal misoprostol for pre-induction cervical ripening: A randomised controlled trial. Aust N Z J Obstet Gynaecol. 2016;56(6):578-84.

Ugwu EO, Obi SN, Iferikigwe ES, Dim CC, Ezugwu FO. Membrane stripping to prevent post-term pregnancy in Enugu, Nigeria: a randomized controlled trial. Arch Gynecol Obstet. 2014;289(1):29-34.

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Published

2020-09-25

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Original Research Articles