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Intracervical Foley Catheter Plus Intravaginal Misoprostol vs Intravaginal Misoprostol Alone for Cervical Ripening: A

Howard Hao Lee1,2, Ben-Shian Huang1,2, Min Cheng1,2

  • 1Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan.

International Journal of Environmental Research and Public Health
|March 15, 2020
PubMed
Summary

Combining Foley catheter with intravaginal misoprostol for labor induction significantly shortens induction time and reduces risks of uterine tachysystole and meconium staining compared to misoprostol alone.

Keywords:
inductionintracervical Foley catheterintravaginal misoprostollaborterm pregnancy

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Area of Science:

  • Obstetrics and Gynecology
  • Reproductive Medicine

Background:

  • Cervical ripening is crucial for labor induction in term pregnancies.
  • Intravaginal misoprostol is commonly used, but its efficacy and safety in combination with other methods require further evaluation.
  • No meta-analysis has directly compared combined intravaginal misoprostol and intracervical Foley catheter with intravaginal misoprostol alone for term pregnancy induction.

Purpose of the Study:

  • To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs).
  • To compare the efficacy and safety of concurrent intravaginal misoprostol and intracervical Foley catheter versus intravaginal misoprostol alone for cervical ripening in term pregnancies.

Main Methods:

  • Systematic search of Embase, Pubmed, and Cochrane databases for RCTs.
  • Inclusion of studies comparing intracervical Foley catheter plus intravaginal misoprostol with intravaginal misoprostol alone.
  • Data extraction and analysis by two independent reviewers, pooling data using random effects modeling.

Main Results:

  • Pooled analysis of eight studies (1110 women) showed a significant decrease in induction time (2.71 h) with the combined method.
  • The combination significantly reduced the risk of uterine tachysystole (RR 0.54) and meconium staining (RR 0.48).
  • No significant differences were observed in cesarean section rates (RR 0.93) or clinical suspicion of chorioamnionitis (RR 1.22).

Conclusions:

  • Concurrent use of intracervical Foley catheter and intravaginal misoprostol is a potentially superior method for labor induction.
  • This combination offers advantages by shortening induction time and lowering risks of uterine tachysystole and meconium staining.
  • The method does not appear to increase cesarean section rates or chorioamnionitis compared to misoprostol alone.