Comparison of PGE2 gel alone versus sequential use of Foley’s catheter and PGE2 gel in the ripening of unfavorable cervix: a retrospective study

Veena Kadadanamari Shankarappa, Preethi Natarajan, Monisha Natarajan


Background: Induction of labor is common procedure practiced in obstetrics. Various methods used for cervical ripening are lacking the proven superiority of one over other. Our study aimed at comparing intracervical PGE2 gel used alone with sequential use of Foley’s catheter and PGE2 gel in order to appreciate reduction in LSCS rate without affecting neonatal outcome.

Methods: The retrospective study was conducted among cases delivered with labor induction between June 2017 to January 2019. Among 104 pregnant women, group1 had received PGE2 gel alone and group 2 had received Foley’s followed by PGE2 gel for induction. The primary outcome included Cesarean section rate and secondary outcomes included improvement in Bishop scores, induction to delivery interval, indication for LSCS, APGAR scores, NICU admission. Data was analyzed and compared.

Results: Both groups were comparable with respect to maternal age, gestational age and indication for induction. There was no significant difference in the mean pre-induction Bishop score between groups. Mean IDI was higher in group 2. There was no difference in mode of delivery, neonatal and maternal morbidity between groups. Higher number of women went into spontaneous labor among group 2 and higher number of women needed oxytocin among group 1 for augmentation.

Conclusions: Intra cervical PGE2 can be safely used among women with unfavorable cervix to achieve faster delivery without increasing LSCS rate. Whereas sequential use of Foley’s catheter and PGE2 gel can be safer alternative for induction of delivery with low risk of oxytocin augmentation when quicker delivery is not needed.



PGE2 gel, LSCS, Foley’s catheter, Induction of labor

Full Text:



Better Outcomes Registry & Network (BORN) Ontario. Perinatal Health Report 2009–2010. Waterloo Wellington and Hamilton Niagara Haldimand Brant-LHINs 3 & 4. Ottawa ON: BORN; 2011.

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;121:247-5.

Deshmukh VL, Yelikar KA, Deshmukh AB. Comparative Study of Intra-cervical Foley’s Catheter and PGE2 Gel for Pre-induction Ripening (Cervical). J Obstet Gynecol Ind. 2011;61(4):418-21.

Pennell C, Henderson J, O’Neill M, McCleery S, Doherty D, Dickinson J. Induction of labor in nulliparous women with an unfavorable cervix: A randomized controlled trial comparing double and single balloon catheters and PGE2 gel. Int J Obstet Gynaecol. 2009;116:1443-52.

Khamaiseh K, Al-Ma'ani W, Abdalla I. Prostaglandin E2 versus Foley catheter balloon for induction of labor at term: a randomized controlled study. J Raman Mathemat Soc. 2012;19:42-7.

Boulvain M, Kelly A, Lohse C, Stan C, Irion O. Mechanical methods for induction of labor. Cochrane Database Syst Rev. 2012;3:297-9.

Chowdhary A, Baggaa R, Kalraa J, Jaina V, Sahaa SC, Kumarb P. Comparison of intracervical Foley catheter used alone or combined with a single dose of dinoprostone gel for cervical ripening: a randomized study. J Obstet Gynecol. 2019;39(4):461-7.

Li Y, He Z, Song L, Zhang J, Wang J, Cheng J, Foley catheter balloon versus prostaglandins for cervical ripening and labor induction: a systematic review and meta-analysis. Int J Clin Exp Med. 2016;9(4):7573-84.