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Abstract
Currently, there is no meta-analysis comparing intravaginal misoprostol plus intracervical Foley catheter versus intravaginal misoprostol alone for term pregnancy without identifying risk factors. Therefore, the purpose of this study is to conduct a systematic review and meta-analysis of randomized control trials (RCTs) comparing concurrent intravaginal misoprostol and intracervical Foley catheter versus intravaginal misoprostol alone for cervical ripening. We systematically searched Embase, Pubmed, and Cochrane Collaboration databases for randomized controlled trials (RCTs) comparing intracervical Foley catheter plus intravaginal misoprostol and intravaginal misoprostol alone using the search terms “Foley”, “misoprostol”, “cervical ripening”, and “induction” up to 29 January 2019. Data were extracted and analyzed by two independent reviewers including study characteristics, induction time, cesarean section (C/S), clinical suspicion of chorioamnionitis, uterine tachysystole, meconium stain, and neonatal intensive care unit (NICU) admissions. Data was pooled using random effects modeling and calculated with risk ratio (RR) and 95% confidence interval (CI). Pooled analysis from eight studies, including 1110 women, showed that labor induction using a combination of intracervical Foley catheter and intravaginal misoprostol decreased induction time by 2.71 h (95% CI −4.33 to −1.08, p = 0.001), as well as the risk of uterine tachysystole and meconium staining (RR 0.54, 95% CI 0.30–0.99 and RR 0.48, 95% CI 0.32–0.73, respectively) significantly compared to those using intravaginal misoprostol alone. However, there was no difference in C/S rate (RR 0.93, 95% CI 0.78–1.11) or clinical suspicion of chorioamnionitis rate (RR 1.22, CI 0.58–2.57) between the two groups. Labor induction with a combination of intracervical Foley catheter and intravaginal misoprostol may be a better choice based on advantages in shortening induction time and reducing the risk of uterine tachysystole and meconium staining compared to intravaginal misoprostol alone.
Highlights
Labor induction with a combination of intracervical Foley catheter and intravaginal misoprostol may be a better choice based on advantages in shortening induction time and reducing the risk of uterine tachysystole and meconium staining compared to intravaginal misoprostol alone
Intracervical Foley catheter is the most common mechanical method that was first described by Embrey and Mollison in 1967, where a Foley is inserted into the cervical canal and dilated just past the internal os with mild traction outward dilating the cervix directly, as well as indirectly stimulating prostaglandin (PG) and oxytocin secretion [31,32,33,34,35,36,37,38]
Studies were included if they were of randomized control trials (RCTs) design comparing combined intracervical Foley catheter and intravaginal misoprostol versus intravaginal misoprostol only for the purpose of cervical ripening and induction in viable singleton pregnancies
Summary
Labor induction (induction of labor-IOL), or initiating labor before spontaneous onset of labor in a viable pregnancy, is often considered when the benefits of induction outweigh the risks of continued pregnancy or at the request of the pregnant women at term [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23] In modern obstetrics, it is an increasingly common practice and offers a better care for both fetus and mother. Intracervical Foley catheter is the most common mechanical method that was first described by Embrey and Mollison in 1967, where a Foley is inserted into the cervical canal and dilated just past the internal os with mild traction outward dilating the cervix directly, as well as indirectly stimulating prostaglandin (PG) and oxytocin secretion [31,32,33,34,35,36,37,38]
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