Obstetric Procedures Research Articles

Study of Labour Induction with Foley's Catheter and Misoprostol in Comparison with Misoprostol Alone and Its Effect on Fetal and Maternal Outcome

Background: Induction of labor is an obstetric procedure in which termination of pregnancy is done at or after the age of viability by medical, surgical or combined method, with the purpose of initiation of labour and vaginal delivery. The objective of this study was to compare the efficacy of vaginal misoprostol in combination with Foleys catheter with vaginal misoprostol alone for labor induction.Materials and Methods: This was a hospital based comparative study done in pregnant women with a medical or obstetrical indication for induction of labor between the age group of 20-35 years. Total of 200 patients were included. Subjects were randomly assigned into two groups Group A (Foleys + Misoprostol) and Group B (Misoprostol alone). Primary and secondary outcomes were analyzed and statistical analysis performed.Results: The induction to delivery time was shorter in Foleys with misoprostol group as compared to misoprostol group alone by 3.67 hours. There was no significant difference in the mode of delivery and maternal and fetal complications between the two groups.Conclusion: The addition of Foleys catheterization to vaginal misoprostol has a synergistic effect and results in early cervical ripening and delivery.

Renal cyst mimicking hydronephrosis after uterine artery ligation for postpartum haemorrhage.

The proximity of the uterus and the cervix to the urinary tract predisposes the latter to injury during obstetrical and gynaecological surgical procedures. Following a difficult surgical procedure on the lower uterine segment and or adnexa, urinary tract injury should be excluded. A booked 39-year-old G3P2 lady who suffered an ischaemic stroke in the index pregnancy had a caesarean delivery at 39 weeks of gestation and sustained an extensive tear that extended inferiorly on the left lateral aspect of the uterus and this resulted in postpartum haemorrhage. Following the repair of the tear, uterine artery ligation was performed to achieve haemostasis. Postoperatively, conventional ultrasonography which was performed to exclude ureteric injury suggested left hydronephrosis and a preliminary report of computerized tomography (CT) showed the same finding. The patient subsequently had left ureteric stenting. The final report of the CT scan was delayed but showed a simple left renal cyst and no hydronephrosis. Renal cyst is a differential diagnosis of hydronephrosis. Delayed availability of the final result of medical investigations jeopardises patients' safety. A preliminary imaging report is prone to error and its use to determine the indication for an invasive procedure should be limited to emergencies.

IATROGENIC COMPLICATIONS OF SURGICAL ABORTIONS IN FIRST TRIMESTER IN COVID-19 PANDEMIC

Dilatation and evacuation is a very common obstetric procedure practiced almost on a daily basis in all hospitals. Complications associated with it are several, including bleeding, perforation, infection, adhesions. The overall perforation rate for rst trimester 1,2 abortions is around 0.8–1.3 per 1,000 according to different authors. However, the incidence varies due to under reporting as underqualied practitioners still carry on abortions at unauthorized centres resulting in such complications. Some inadvertent complications also might occur at tertiary care centres which are managed immediately under direct vision. COVID 19 pandemic had created limitation of resources and travel for the common, causing patients to undergo procedures at the nearest available centres, irrespective of authorization of such procedures at those centres and thereby resulting in complications. Here we present a series of three cases of uterine perforation occurring as complication of dilatation and evacuation, two of which were carried out in private centres which had further resulted in bowel injury or broad ligament hematoma.

Unavoidable Caesarean Myomectomy Due to Multiple Anterior Uterine Fibroids: A Case Report

Background: Caesarean myomectomy is still a controversial issue in current obstetric practice due to the fear of uncontrollable haemorrhage. However, it may become very necessary occasionally with increased prevalence of fibroids among our pregnant mothers. Case Report: We report a case of Mrs UC, a 30-year-old primigravid woman who booked for antenatal care at 16 weeks gestational age following a 3-year history of infertility. The pregnancy was complicated with abdominal pain from red degeneration of uterine fibroid and was managed with pentazocine in the 2nd trimester. She presented in labour at 39 weeks and 4 days but labour was prolonged for 8 hours, having adequate contractions without any significant improvement in both descent and cervical dilatation. She subsequently had an emergency caesarean myomectomy with an outcome of a live female neonate that weighed 3.1kg with good Apgar scores and 2 pieces of uterine myoma that weighed 1.1kg. The post-operative and puerperal periods were uneventful. Conclusion: Caesarean myomectomy, a controversial obstetric procedure, can be indicated when the location and size of the fibroid mass makes caesarean delivery only very challenging and difficult.

History of caesarean section

Cesarean section is a obstetric procedure known since ancient times. It is mentioned in almost all ancient cultures. While until the 17th century it was performed mainly post mortem to retrieve an infant from the body of the deceased mother, today there are many indications for termination of pregnancy in this way. Literature provides references to earlier attempts to save the mother, but this happened only sporadically. The first record of a cc that both mother and child survived dates back to 1500. The development of science and medicine contributed to the dissemination and improvement of the methods used to extract a child by caesarean section. It was influenced by the development of operational, anesthetic and aseptic techniques. A milestone was the introduction of the Pfannenstiel – Kerr lower transverse incision method. Later, the Misgav-Ladach technique was introduced. Today, transverse incisions are most commonly used.

Anaesthesia and the development of functional neurological disorder: A systematic review and case series

ObjectiveThere are reports of functional neurological disorder (FND) developing after anaesthesia, though separating any aetiological role from other possible factors is challenging. We aimed to systematically review all published cases of post-anaesthetic FND to see if any common factors supported an anaesthetic role. We also aimed to identify all cases of post-anaesthetic FND arising in our FND clinic, to obtain an estimate of its frequency. MethodsFor the review, a systematic search for published cases of FND developing within 48 h of anaesthesia was conducted in June 2022. For the case series, the medical records of all patients attending an FND clinic in Melbourne between 2017 and 2019 were examined, and all cases with FND within 48 h of anaesthesia extracted. Results36 published cases were identified for the review. Sixteen described preceding stressors and 16 psychiatric diagnoses, including 8 with previous FND. Thirty-two (92%) had undergone general anaesthesia, most commonly for obstetric procedures. Motor/sensory loss was the most common presentation, followed by seizures and coma. Most (80.5%) developed symptoms immediately on induction or cessation of anaesthesia. For the case series, 8 of 107 clinic patients (7.5%), developed FND within 48 h of anaesthesia. All had previous psychiatric diagnoses, including 3 with previous FND. Three underwent general anaesthesia and 3 procedural sedation, with seizures the most common presentation. All developed symptoms immediately on induction or cessation of anaesthesia. ConclusionThese cases provide some support for an aetiological role for anaesthesia: there is evidence for an anaesthetic ‘model’ for the symptoms of FND that arise, they largely arise with the onset or termination of anaesthesia, and they arise most frequently during general anaesthesia or sedation.

Isthmocele: The “Hot Air Balloon Sign,” a Gynecologic Consequence of an Obstetric Procedure

Cesarean section is the most common surgical procedure performed on women of reproductive age [1]. Occasionally, the hysterotomy incision's healing leaves areas of myometrial loss of continuity creating pouchlike defects known as isthmocele. Such defects function as reservoir collecting menstrual blood generating postmenstrual spotting, pelvic pain, dyspareunia, and secondary infertility among other symptoms [2]. Saline infusion sonogram is an effective imaging modality [3]. Both surgical and nonsurgical options have been recommended for the treatment of patients with symptomatic isthmocele [4].

Functional outcomes of surgical treatment of ureteral injury following gynecological and obstetrical surgery

IntroductionIatrogenic ureteral lesions represent one of the serious complications that can follow obstetric and gynecological surgery. This condition has a fatal consequence on renal function if it's not promptly diagnosed and managed. ObjectiveThe aim of our study was to report our experience in the management of this pathology. Materials & MethodsThis is a retrospective study of 32 patients treated for an iatrogenic ureteral injury after gynecological or obstetrical surgery, collected in the urology department of the Rabta Hospital over a 15-year period (2005–2020). Clinical presentation, investigations, and operative and postoperative details were reviewed from the patients' charts. ResultsThe average age of the patients was 42.6 (21–61). Multiparity was observed in 90.6% of cases. Hysterectomy was the most common cause (71.87%), followed by cesarean operation (18.75%), mainly for patients with placenta percreta (12.5%), and lastly, cure of prolapse by the upper approach in 9.37% of cases. The symptoms were dominated by low back pain and urinary incontinence. Stenosis was the most frequent lesion in 25 cases, followed by a section in 4 cases. A ureterovaginal fistula was observed in 3 case s. The first-line treatment of the patients was drainage by a ureteral stent (15.6%) or by a percutaneous nephrostomy (84.4%). Ureterovesical reimplantation was performed in 26 cases (81.25%). However, one patient had an Ileal ureter replacement. During follow-up, treatment failure was noted in 7 patients. Four patients developed secondary hydronephrosis treated with a urethral stent while 3 patients required nephrectomy. The type of gynecological and obstetrical procedure (open hysterectomy), history of pelvic surgery, and malignant pathology were predictive factors of treatment failure. ConclusionsInjuries to the ureter during gynecological and obstetrical surgery are generally rare. The diversity of repair techniques and the contribution of endo-urological techniques most often allow renal preservation, knowing that the best treatment remains prevention.

The Joel-Cohen laparotomy: A dilapidating access source of wide and complex suprapubic incisional hernia

This retrospective study aims to describe morphological and therapeutic peculiarities of the suprapubic incisional hernia (SIH) encountered after a Joël-Cohen laparotomy. Serie-report: 9 patients had an SIH, 2 were sub-umbilical and did not concern the suprapubic scar, 3 were central, 2 on the whole length of the suprapubic scar, and 2 were bilateral in one case associated to a sub-umbilical incisional hernia. SIH were wide openings, with a hernial fascia constituted from the anterior fascia, without connexion with the parietal peritoneum, in a sub-umbilical position above the suprapubic scar, or through the suprapubic scar. Rectus muscle was ruptured or sclerosed. There were 2 distinct defects, an anterior one through the anterior fascia, and a posterior one between the rectus muscles. The parietal peritoneum was retracted leaving bare the posterior side of the rectus muscles. There was an interstitial retro-fascial space, so the SIH was bisaccular. When releasing the parietal peritoneum was not feasible, the prosthesis was placed in a retro-fascial space. When the parietal peritoneum was released, the prosthesis was placed in a preperitoneal space. The anterior defect closure was not always completely feasible, fulfilled with a Vicryl prosthesis. One patient presents an abdominal wall bulging in case of efforts. SIH after a Joël-Cohen laparotomy is wide and dilapidating. The cure is difficult. This technique should be reserved to real emergency obstetrical procedure. We highlight the importance of the parietal peritoneum closure after gynecological or obstetric surgery.

Factors Associated with Post-caesarean Complications in Emergency of Gynecology-Obstetrics Service of Saint Joseph Hospital in Kinshasa, Democratic Republic of the Congo

Caesarean section is the most common surgical procedure in obstetrics, but also in pregnant women with dystocia. The purpose of this study is to identify factors that contribute to post-caesarean complications in emergency of gynecology-obstetrics service of Saint Joseph Hospital in Kinshasa. This is a descriptive cross-sectional study and was conducted at Saint Joseph Hospital in Kinshasa city for a month (1st and 30th July 2021). A questionnaire was used to collect different data namely socio-demographic characteristics and different variables important for the study. Independent variables were factors related to the parturient and the current pregnancy, the surgical procedure and the operational room. While the dependent variable was post-caesarean complications in gynecology-obstetrics service. Descriptive statistical analyses namely frequency and percentage were done to describe the sample profile. To measure the strength of association between different variables were estimated using Pearson's Chi-Square (X2) test and the p-value was 0.05. Data analysis was performed using SPSS version 20 software. The majority of participants are over 33 years of age, have secondary school skills, married and have 3 to 4 children. It was observed that 88.2% of participants have acute respiratory distress prior to caesarean section, 76.6% have a personal history of thromboembolic disease prior to caesarean section. All the participants who underwent caesarean section were victims of external ventilation through the windows of the operating room, which remained open before, during and after the surgery and benefited from antibiotic treatment without any para-clinical analysis before the caesarean section. Furthermore, 82.4% of participants had benefited from the caesarean section with sterilized care materials 48 hours before and after the intervention. While 47.1% of participants had caesarean sections with defective equipment for the operation (use of dry heat sterilization etc.). A better identification of these risk factors can reduce significantly rate of complications and can consequently improve the maternal-infantile prognosis. The obstacles to effective management are related to the provision of quality services.

A Systematic Review of Risk Factors for Hepatitis C Virus Infection Among Low-Risk Population in India

Identification of risk factors for hepatitis C virus (HCV) transmission will help in targeted screening of people who are at risk for HCV. Indian studies, published between January 1989 and June 2020, were systematically reviewed to identify the relevant studies. We searched electronic databases including PubMed/Medline, Embase, Scopus, and Google scholar to identify the original data published in English language. The full-text studies, published in any form, which reported data on risk factors for HCV transmission among low-risk population were selected. The studies which exclusively included high-risk groups were excluded. Data were extracted from 31,176 participants included in 25 studies (median [range] 40 [7-20,113). The participants were HCV infected patients who visited the hospital (n=10), community population (n=6), pregnant women (n=5), blood donors (n=2), people with diabetes mellitus (n=1), army recruits (n=1), or slum dwellers (n=1). These studies provided data on blood transfusion, use of unsafe injections, minor or major surgery, unsafe dental procedures, tattooing, body piercing, obstetrical procedures, unsafe shaving, intravenous drug use, and unsafe sexual practices as risk factors for HCV transmission. Unsafe injections, body piercing, unsafe dental procedure, unsafe shaving, and tattooing were identified as major risk factors for reported by HCV population participants.More data are needed to identify the risk factors for HCV in Indian population. Risk-factor-targeted screening may increase the yield and reduce the cost of HCV screening in India.

Obstetric Anesthesia Practice in the Tertiary Care Center: A 7-Year Retrospective Study and the Impact of the COVID-19 Pandemic on Obstetric Anesthesia Practice.

There are many benefits of neuraxial anesthesia (NA) in the obstetric population. We performed a retrospective analysis of anesthesia provided to obstetric patients in the tertiary care center between 1 January 2014 and 31 December 2020 and the influence of the COVID-19 pandemic on anesthetic practice. A total of 15,930 anesthesia procedures were performed. A total of 2182 (17.52%) cesarean sections (CS) required general anesthesia (GA), including 383 (3.07%) of emergency conversion from NA. NA for CS consisted of 9971 (80.04%) spinal anesthesia (SA) and 304 (2.44%) epidural anesthesia (EPI). We found a decrease in the GA rate for CS in 2020 (11.87% vs. 14.81%; p < 0.001). The conversion rate from NA to GA for CS was 2.39% for SA and 31.38% for EPI. The conversion rate from labor EPI to SA for CS increased in 2020 (3.10% vs. 1.24%; p < 0.001), as well as the SA rate for other obstetric procedures (61.32%; p < 0.001). We report 2670 NA for vaginal delivery, representing 31.13% of all vaginal deliveries. NA constituted the vast majority of obstetric anesthesia. However, we report a relatively high incidence of GA. There was a decrease in GA use in the obstetric population during the pandemic. Further reduction in GA use is possible, including an avoidable conversion from NA to GA.

LGBTQ+ health and anaesthesia for obstetric and gynaecological procedures.

People who self-identify as lesbian, gay, bisexual, transgender, queer, two-spirited and intersex (LGBTQ2SI) make up approximately 10% of the US population. Black, Native American and Latino/a/x communities are known to have a higher percentage of people who self-identify as LGBTQ2SI than white communities. Despite growing acceptance of LGBTQ2SI communities in the USA, these populations continue to experience health inequities. This review article will provide a narrative review of recent publications that discuss topics of LGBTQ2SI health and anaesthetic care during obstetric and gynaecological procedures. Of the articles reviewed for this study, there were four main themes that emerged: inclusion of LGBTQ2SI health topics in curriculum and provider training materials; social determinants of LGBTQ2SI reproductive and overall health; improving the quality and safety of perioperative care for LGBTQ2SI communities; and disparities in perinatal anaesthetic care for LGTBQ2SI communities. There are unique considerations when providing anaesthetic care for obstetric and gynaecological procedures to LGBTQ2SI communities. There is a limited, yet growing, body of literature exploring this aspect of perioperative and perinatal care. Researchers and clinicians must continue to pursue clinical research which seeks to improve the quality of care we provide all patients.

Evolution in caesarean section practices in North Kivu: Impact of caregiver training.

A caesarean section is a major obstetric procedure that can save the life of mother and child. Its purpose is to protect the mother's health from the complications of childbirth and to protect the baby's health. In sub-Saharan Africa (SSA), there are major inequalities in access to caesarean sections and significant variations in practices to determine the indications for the procedure. Periodic analyses of maternal deaths have shown that more than half of maternal and new born deaths are due to suboptimal care and are therefore potentially preventable. The objective of our study is to assess the impact of health staff training under the PADISS project (to support the health system's integrated development) on the quality of CS procedures in North Kivu, by comparing two periods. The populations compared were recruited from the referral hospitals in North Kivu, DRC (Democratic Republic of Congo). The first (group 1) was made up of patient files studied retrospectively for the period from 01/11/2013 to 01/01/2016. The second group (group 2), studied prospectively, comprised patient files from June 2019 to January 2020. Obstetric, maternal and foetal data were compared. Statistical analyses were performed using STATA/IC 15.0 for Windows. Univariate and multiple logistic regression was performed to determine which characteristics are associated with maternal and perinatal morbidity and mortality. A p value < 0.05 was considered statistically significant. CS frequency was approximately 17% in both study periods. We observed a CS frequency of about 34% at North Kivu provincial hospital for the two populations studied. The main indications for CS were dystocia, foetal distress and scarred uterus for both populations. In the population studied prospectively, after the implementation of health staff training, there were fewer incidence rate of dystocia, foetal distress and neonatal death, a more complete patient record, shorter hospital stay, and fewer blood transfusions but more incidence rate of scarred uterus, post-operative complications and low birth weight. Intervention had no statistically significant impact on low birth weight (OR = 1.9, p = 0.13), on neonatal mortality (OR = 0.69, p = 0.21). Our study shows a decrease in neonatal deaths, dystocia and foetal distress, but an increase in post-operative complications, maternal deaths and cases of scarred uterus and low birth weight. However, multiple logistic regression did no support the conclusion.

Compliance with clinical guidelines increases the safety of vacuum-assisted delivery.

Vacuum-assisted delivery (VAD) is a common and safe obstetric procedure. However, occasionally serious complications may occur. Clinical guidelines and College Statements have been developed to reduce the risk of serious adverse events. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College Statement C-Obs 16 has not been evaluated to see if advice improves outcomes. The aim was to evaluate whether compliance with RANZCOG College Statement C-Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma. Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021. There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, P= 0.0002), major birth trauma (3% vs 22%, P= 0.0001), requirement for neonatal resuscitation (14% vs 35%, P= 0.0026) and Apgar scores at oneminute less than six (5% vs 22% P= 0.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388 mL vs 438 mL, P= 0.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, P= 0.02) and birth requiring instrument change (4% vs 13% P= 0.031). Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three. Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery.

Rational use of antibiotics for major elective gynaecological and obstetrical surgical procedures: quality improvement journey from a tertiary care public facility

BackgroundAntibiotic resistance is a global problem. Irrational use of antibiotics is rampant. Guidelines recommend administration of single dose of antibiotic for surgical antimicrobial prophylaxis (SSAP) for elective obstetrical and gynaecological...

Hands-on Simulation Workshop for Obstetric Ultrasound-Guided Invasive Procedures.

IntroductionDue to the introduction of cell-free DNA genetic testing options, the number of clinical ultrasound procedures has greatly diminished in recent years. With fewer real-life ultrasound-guided procedures being performed, it is difficult for OB/GYN and maternal-fetal medicine (MFM) trainees to achieve competency in doing them. Simulation can be utilized to address this issue and supplement a learner's real-life training.MethodsWe developed a simulation workshop incorporating previously described ultrasound guidance task trainers and simulators of amniocentesis and chorionic villus sampling. The workshop had three parts: needle guidance basics, targeting task performance, and procedure-specific simulation. A form of this workshop has been held at the annual meeting of the Society for Maternal-Fetal Medicine since 2015 and as a regional course for MFM fellows since 2017. During the 2019 and 2020 courses, participants completed Likert-scale surveys evaluating the course.ResultsSince the workshops began in 2015, approximately 300 people have participated. In 2019–2020, 41 MFM attending physicians, 136 MFM fellows, and three OB/GYN residents took our course and completed a postcourse survey. Participants rated the course highly and thought it was highly effective.DiscussionWe created an introductory simulation workshop for obstetric ultrasound-guided invasive procedures that participants rated highly and thought was very effective. Objective clinical assessment of skill improvement after completion of this course is needed to verify its true impact. Repeated exposure to this introductory simulation and creation of more challenging workshops are needed to achieve a sustained high level of procedural skill.

Negative pressure wound therapy for surgical wounds healing by primary closure.

Negative pressure wound therapy for surgical wounds healing by primary closure.

Peripartum hysterectomy due to severe postpartum hemorrhage: A hospital-based study.

A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to peripartum hysterectomies are mainly caused by uterine atony and placenta accreta spectrum disorders. In this study, we aimed to estimate the incidence, risk factors, causes and management of severe postpartum hemorrhage resulting in peripartum hysterectomies, and to describe the complications of the hysterectomies. Eligible women had given birth at gestational week 23+0 or later and had a postpartum hemorrhage ≥1500 mL or a blood transfusion, due to postpartum hemorrhage, at Oslo University Hospital, Norway, between 2008 and 2017. Among the eligible women, this study included those who underwent a hysterectomy within the first 42 days after delivery. The Norwegian Medical Birth Registry provided the reference group. We used Poisson regression to estimate adjusted incidence rate ratios with 95% confidence intervals to identify clinical factors associated with peripartum hysterectomy. The incidence of hysterectomies with severe postpartum hemorrhage was 0.44/1000 deliveries (42/96313). Among the women with severe postpartum hemorrhage, 1.6% ended up with a hysterectomy (42/2621). Maternal age ≥40, previous cesarean section, multiple pregnancy and placenta previa were associated with a significantly higher risk of hysterectomy. Placenta accreta spectrum disorders were the most frequent cause of hemorrhage that resulted in a hysterectomy (52%, 22/42) and contributed to most of the complications following the hysterectomy (11/15 women with complications). The rate of peripartum hysterectomies at Oslo University Hospital was low, but was higher than previously reported from Norway. Risk factors included high maternal age, previous cesarean section, multiple pregnancy and placenta previa, well known risk factors for placenta accreta spectrum disorders and severe postpartum hemorrhage. Placenta accreta spectrum disorders were the largest contributor to hysterectomies and complications.

Comparative study of Foley’s catheter and prostaglandin E2 gel for pre-induction cervical ripening

Background: Induction of labor is a crucial and customary clinical procedure in obstetrics. It is arguably one of the most abused procedures. Cervical ripening determines the success of delivery. The availability of newer oxytocics and induction techniques which are simpler and also more predictable has significantly modified our traditionally conservative attitude toward induction of labor. Aims and Objectives: The objective of this study was to determine the effectiveness of Foleys catheter against prostaglandin E2 (PGE2) gel for pre-induction cervical ripening. Materials and Methods: Women attending hospital for induction of labor, with a Bishop’s score &lt;6, were allocated randomly to Foley’s group (Group F) and PGE2 gel group (Group P). Fifty women were allocated to Foley’s group (Group F) and 50 were allocated to gel group (Group P). The Foley’s group had a number 18 Foley catheter inserted into cervix, bulb inflated and placed on traction. Further augmentation was done, after Foleys extrusion or 6 h after gel, either with PGE2 gel or oxytocin solution depending on Bishops score. Results: The Foley’s group had significantly higher change in Bishop’s score (3.12 vs. 2.66, P=0.04). The Foleys group required lesser number of further doses of gel as compared to gel group. No differences were found between the two groups with respect to induction to delivery interval, mode of delivery, non-reassuring fetal heart rate patterns, or baby weight. Conclusion: Foleys catheter was associated with greater change in Bishops score as compared to intracervical PGE2 gel. It was not associated with any side effect during induction process.