Abstract
BackgroundBeing one of the most common indications of labor induction, postdate pregnancy can lead to serious maternal and fetal complications. In this study we aimed to compare vaginal misoprostol with intracervical Foley catheter (FC) for cervical ripening in postdate primigravid women.MethodsThis randomized clinical trial included 120 primigravid women aged 18–35 years with singleton, postdate pregnancies, and Bishop score ≤ 4. Participants were randomized into two equal groups. The first group received 25 µg vaginal misoprostol and the second group had an 18 Fr FC inserted into their cervical canal. Labor induction was performed using oxytocin in both groups if progression of labor or true contractions did not occur within 6 h of the interventions. In case of nonreassuring fetal heart rate, fetal distress, placental abruption, or prolonged labor, C-section was performed.ResultsThe frequency of normal vaginal delivery, Cesarean section, meconium-stained amniotic fluid, and neonatal intensive care unit admission did not differ significantly between groups. Placental abruption and uterine tachysystole occurred more frequently in the misoprostol group (15.0 vs. 1.7%, P = 0.008 and 21.7 vs. 0.0%, P < 0.001, respectively). A significantly higher number of women in the FC group required oxytocin (73.3 vs. 41.7%, P < 0.001). Duration of labor was significantly higher in the FC group (P = 0.001).ConclusionsDue to the lower rate of placental abruption and uterine tachysystole observed with FC, it appears to be superior to vaginal misoprostol for cervical ripening in postdate primigravid women; however, its longer labor duration and higher oxytocin requirement should be taken into consideration.Trial registrationIranian Registry of Clinical Trials, IRCT20181218042033N4. Registered 19/04/2020. Retrospectively registered, https://www.irct.ir/trial/47037
Highlights
Postdate pregnancy, defined as extension of pregnancy to over 40 weeks of gestation, accounts for 5–14% of all deliveries across different studies [1,2,3]
The frequency of normal vaginal delivery (NVD) and C-section were comparable between the misoprostol and Foley catheter (FC) groups (73.3 vs. 85.0%, P = 0.116 and 26.7 vs. 15.0%, P = 0.116, respectively)
Significantly more women in the FC group required oxytocin compared to the misoprostol group (P < 0.001)
Summary
Postdate pregnancy, defined as extension of pregnancy to over 40 weeks of gestation, accounts for 5–14% of all deliveries across different studies [1,2,3]. Postdate pregnancy is among the most common indications of labor induction whose success depends upon the degree of cervical ripening evaluated by the Bishop score [9]. Cervical ripening which is the process of softening and stretching of the cervix, is a prerequisite for labor induction, in that an unripe cervix with a low Bishop score significantly increases the risk of induction failure compared to a favorable cervix [10]. Due to a twofold increased risk of infection with FC, it is contraindicated in pregnant women with apparent infection [13] This method is generally endured well by women, it may result in discomfort, pain, anxiety, and mild bleeding; it is mostly considered efficacious and safe [11]. In this study we aimed to compare vaginal misoprostol with intracervical Foley catheter (FC) for cervical ripening in postdate primigravid women
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