Preinduction Cervical Ripening Research Articles

Preinduction cervical ripening in an outpatient setting: a prospective pilot study of a synthetic osmotic dilator compared with a double-balloon catheter.

To compare the effectiveness, safety and patient satisfaction of a double balloon catheter (DB) with a synthetic osmotic cervical dilator (OD) for pre-induction cervical ripening in an outpatient setting. This is a prospective, dual-center pilot study including 94 patients with an unripe cervix (Bishop Score <6) near term; 50 patients received the DB and 44 patients the OD. The primary outcomes were the difference in Bishop Score (BS) and cervical shortening. Pain perception at insertion and during the cervical ripening period was evaluated by a visual analogue scale and patient satisfaction by a predefined questionnaire. The use of DB was associated with a significantly higher increase in BS (median 3) compared to OD (median 2; p=0.002) and resulted in significantly greater cervical shortening (median -14mm vs. -9mm; p=0.003). There were no serious adverse events at placement of devices or during the cervical ripening. There were no significant differences in perinatal outcomes. Pain perception during cervical ripening was significantly higher (p<0.001), and patient satisfaction regarding sleep, relaxing time and performing desired daily activities were significantly lower in patients with DB compared to patients with OD (p<0.001). DB was superior to OD regarding cervical ripening based on BS and on sonographic measurement of the cervical length. Patients with OD experienced less pain during cervical ripening and were more satisfied with the method compared to patients with DB.

Efficacy of Dilapan S compared to foley balloon in preinduction cervical ripening—a noninferiority trial

The need for induction of labor is increasing in present obstetric practice. The available non-pharmacological methods for cervical ripening at term are Foley balloon and Dilapan-S. With the gaining popularity of Dilapan-S worldwide, there are very few clinical trials conducted in India to evaluate its effectiveness. To compare the efficacy of Dilapan-S and Foley balloons for pre-induction cervical ripening. This single-center randomized non-inferiority trial included primi- and multi-gravida women between 37 and 41 weeks of gestation and unfavourable cervix with a Bishop's score between 0 and 2. Using a random number table, patients were assigned to study Group 1 Dilapan-S and to control Group 2 Foley balloon. Dilapan-S or Foley balloon was inserted intracervically and assessed for dilation after 12 hours. Patients with unfavourable dilatation were further provided prostaglandins (PgE 1 and 2) for further augmentation of induction. Primary outcome measures included improvement in Bishop's score, and mode of delivery, followed by time to delivery from intervention, use of other augmentation methods, and maternal and neonatal outcomes. After screening, 296 patients with Bishop score less than 2, (148 in each group) were enrolled in the study. The number of patients who had vaginal delivery was comparable between both groups (p=.72), and so were the maternal outcomes. Two cases of cord prolapse occurred with Foley balloon. Group 2 showed significant improvement in Bishop's score (p<.001), and Group 1 had a significantly higher use of augmentation with PgE1 (p-.01) and PgE2 (p<.001). The number of contractions was significantly lower in Group 1 (p<.001), and contraction intensity was higher in Group 2. There was no significant difference in cesarean delivery for failed induction of labor between the groups (p=.72). Based on the primary outcome measure, Dilapan-S was found to be non-inferior to the Foley balloon. Dilapan-S is non-inferior to Foley balloon in achieving pre-induction cervical ripening in term pregnancies, and therefore Dilapan-S can be suggested as an alternative in clinical practice with minimal risks.

Assessing the effectiveness of membrane sweeping combined with cervical massage for term pre-induction cervical ripening: A single experimental study

Massage of the cervical region entails applying light pressure to the cervix to trigger the uterine contractions. Membrane sweeping, often called cervical sweeping or membrane stripping, releases hormones that may start labor by removing the amniotic sac from the uterine wall. Although membrane sweeping is helpful in several clinical trials, no studies have examined how effective cervical massage is when combined with membrane sweeping.This research compared the effectiveness of membrane sweeping and cervical massage as cervical ripening techniques in post-dated pregnancies before labor induction in specialized clinics. A total of 150 low-risk singleton pregnancies with a Modified Bishop Score (MBS) of fewer than five at 38 weeks of gestation were included. The experimental group received membrane sweeping with cervical massage, and the control group, which just received membrane sweeping, was randomly allocated to the participants. 48 hours after the intervention, changes in the MBS were used to gauge cervical favorability. Neonatal morbidity, membrane rupture, intrapartum and postpartum infections, and other complications were assessed.The mean ages and MBS of the primigravidae in the two research groups at induction were similar. After the intervention, the trial group's mean MBS was significantly higher than the control groups. Because of this, primigravidae observed a substantial change in the MBS after the operation. The experimental group's adverse effects and neonatal morbidity were comparable, except cardiotocographic abnormalities were observed more often in the control group.In some cases, when membrane sweeping cannot be conducted because of a closed cervical os, cervical massage combined with membrane sweeping appears successful and secure. A significant choice for obstetric care, this technique may aid cervical softening in post-dated pregnancies.

Effect of Oral Mifepristone on Modified Bishop's Score in Term Pregnancy.

Modern-day obstetrics recommend induction of labor by medical or mechanical methods where continuation of pregnancy causes detrimental effect to the health of mother or fetus. One of the prerequisites for successful vaginal delivery includes a favorable or ripe cervix. We undertook the present study to find out the safety and efficacy of mifepristone for pre-induction cervical ripening and its effect on Bishop's score in term pregnancy. A total of 100 patients with term pregnancy were enrolled for this study. 200 mg of mifepristone was administered orally, and efficacy of mifepristone was assessed based on improvement in modified Bishop's score at 48 h. If there was inadequate improvement in Bishop's score after 48 h, additional intracervical cerviprime was administered for induction. Out of 100 patients, 50 women delivered vaginally after administration of mifepristone. Twenty-four patients delivered vaginally within 48 h of administration of mifepristone. We observed the Bishop's score of 6 or moreat 48 h in 69% participants. Fifty patients required additional intracervical cerviprime. Thirty participants underwent cesarean section. Mean Modified Bishop's score at 0 h was 1.87 and improved to 6.92 after 48 h after mifepristone. A statistically significant difference was found with mean Bishop's score with p value < 0.005. In our study, we found that mifepristone is a safe and effective cervical ripening agent in term pregnancy with unfavorable cervix. It is well tolerated and leads to significant cervical ripening with improvement in Bishop's score favoring vaginal delivery.

Pre-induction cervical ripening and hygroscopic cervical dilators in pre-labor induction

Introduction Induction of labor (IOL) is becoming a universal topic in Obstetrics, when the risk of continuing a pregnancy outweighs the benefits. Preinduction is a more recent tool to prepare the cervix when the BISHOP-score is low. About one-third of IOL cases require cervical ripening, which is the physical softening, thinning, and dilation of the cervix in preparation for labor and birth. We report a single center experience regarding the use of hygroscopic dilators in the pre-labor phase to obtain cervical ripening before labor induction. Materials & Methods We conducted a retrospective observational study comparing patient records from the Gynecology and Obstetrics Unit in “Santo Stefano” Hospital in Prato, Tuscany. The inclusion criteria for participants were women who had undergone pre-labor induction because of a BISHOP-score < 3. The gestational age of all the pregnant women was at term (> 37 weeks). Results From January 2022 to April 2022, a total of 581 women delivered at term of gestational age at the Gynecology and Obstetrics Unit in “Santo Stefano” Hospital. Cervical ripening was necessary for 82 women with a Bishop score < 3 and hygroscopic cervical dilators were used in 35/82 (42.7%) patients. All patients showed a change in Bishop-score upon removal of the dilators. All 35 patients (100%) reported an increase in terms of consistency and dilation of the cervix but not in terms of length. None of the patients reported discomfort during the 24 h that they kept the hygroscopic dilators in place. No patients reported uterine tachysystole on cardiotocographic tracing, vaginal bleeding, rupture of membranes or cervical tears. Conclusions Our results are in line with those in the literature, demonstrating the validity of hygroscopic dilators in cervical maturation of pregnancies at term and their efficacy was again highlighted in terms of both maternal and fetal safety and patient satisfaction.

Comparison of Vaginal Dinoprostone Pessary With Transcervical Balloon Catheter Plus Vaginal Misoprostol for Pre-induction Cervical Ripening: A Randomized Trial.

Aims and Objectives To compare the safety and efficacy of dinoprostone pessary with Foley plus vaginal misoprostol for cervical ripening. Materials and Methods We randomized 115 women to the pessary or Foley plus misoprostol group. Pessary was inserted for 24 hours, and in the Foley plus misoprostol group, intravaginal misoprostol 25 mcg was administered along with trans-cervical Foley insertion and repeated every six hours to a maximum dose of 100 mcg. Singleton pregnancies requiring labor induction at more than 34 weeks with a Bishop score of <6 were included. Study outcomes included induction-delivery interval (IDI), mode of delivery, change in the Bishop score, need for oxytocin augmentation, and patient discomfort as assessed by visual analog score. Results The IDI was similar between the groups (pessary vs Foley plus misoprostol; 21.27 vs 21.10 hours, p = 0.9). The mean change in the Bishop score and need for augmentation with oxytocin was significantly more in the Foley plus misoprostol group compared to pessary (2.72 vs 1.94, p = 0.001; 89.7% vs 57.9%, p = 0.0001). Pessary was better tolerated compared to Foley plus misoprostol (VAS 7.8 vs 6.68, p = 0.0001). Mode of delivery and maternal and neonatal outcomes showed no difference. Conclusion There was no significant difference between pessary and Foley plus misoprostol in the IDI and mode of delivery. Pessary was better tolerated, andaugmentation with oxytocin was required less often. Foley plus misoprostol caused a faster change in the Bishop score, but oxytocin augmentation was used more often. Maternal and neonatal outcomes were similar.

Synthetic Osmotic Dilators for Pre-Induction Cervical Ripening - an Evidence-Based Review.

Mechanical methods have gained growing interest for pre-induction cervical ripening in women with an unripe cervix, since they have a better safety profile compared to prostaglandins. Balloon catheters have been the gold standard method for decades, while there was a lack of data on synthetic osmotic cervical dilators. Not until 2015, when Dilapan-S was approved by the Food and Drug Administration (FDA) for induction of labor, numerous studies have been published on the use of Dilapan-S in this field. The rate of vaginal deliveries associated with the use of Dilapan-S ranges from 61.6 to 81.7%, and no serious complications needing further interventions have been reported to this date. Dilapan-S was shown to be as effective as the Foley balloon catheter as well as the 10mg PGE 2 vaginal insert and orally applied misoprostol (25µg every 2 hours) in achieving vaginal delivery, but patient's satisfaction during the cervical ripening process was significantly higher compared to the other methods and the rate of uterine hyperstimulation was significantly lower compared to prostaglandins (PGs). Minor complications (e.g. vaginal bleeding) associated with the use of Dilapan-S were <2%, and maternal infectious morbidity was not higher compared to Foley balloon and vaginal PGE 2 or misoprostol. Due to these beneficial properties Dilapan-S might be an ideal option for outpatient cervical ripening, as shown in a recent randomized clinical trial comparing inpatient to outpatient cervical ripening. Furthermore, according to the manufacturers' product information, Dilapan-S is the only cervical ripening method that is not contraindicated for induction of labor in women with a previous cesarean section. Upcoming guidelines should consider synthetic osmotic cervical dilators as an effective and safe method for cervical ripening/induction of labor acknowledging that more evidence-based data are mandatory, particularly in patients with a previous cesarean section.

Dinoprostone Gel versus Intra-cervical Foley’s Catheter for Pre-induction Cervical Ripening: An audit

Background One of the common practices in modern obstetrical care is labour induction when foetal and maternal complications arise. We endeavoured to compare the efficacy and safety of the inexpensive mechanical method of induction Foley’s catheter to the more established pharmacological agent Intracervical Prostaglandin E2 gel&#x0D; Method The present prospective randomised control study was carried out on 200 women with a term singleton pregnancy in cephalic presentation, with an unfavourable cervix and a valid indication for induction of labour. The patients were randomly allocated using the chit method to either Foley’s catheter [group A, n=100] or PGE2 gel [group B, n=100] . Augmentation with oxytocin was done if required and labor was closely monitored till delivery and the perinatal outcome and maternal side effects was recorded Quantitative variables were compared using unpaired t-test/Mann-Whitney Test and qualitative variables were compared using Chi-Square test /Fisher’s exact test. Analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0&#x0D; &#x0D; RESULTThe caesarean section rate did not show a significant difference between the Foley’s group(18%) and PGE2 group(11%) The incidence of fetal distress, Meconium stained liquor and APGAR score &lt;7 at 5 minutes was significantly with PGE2 as compared to group A. (P&lt;.05) Incidence of hyperstimulation of uterus was reported in 6% women who received PGE2 as compared to none in Foley’s group. The induction delivery interval did not show any significant difference between the two groups.&#x0D; &#x0D; CONCLUSION In women undergoing induction of labour at term in resource constraint set ups like ours, Foley catheter is a good alternative to the more established prostaglandin E2 gel, with good efficacy and better neonatal and maternal safety profile.&#x0D; &#x0D; Keywords: cervical ripening; dinoprostone; obstetric labor, induced

Dinoprostone Vaginal Insert vs Intracervical Foley Catheter for Preinduction Cervical Ripening in Women with Previous Cesarean Section

Dinoprostone Vaginal Insert vs Intracervical Foley Catheter for Preinduction Cervical Ripening in Women with Previous Cesarean Section

Efficacy of Prostaglandin Analogues for Induction of Labour and Associated Complications: A Retrospective Research Study conducted in Latifa Women and Children Hospital

Induction of labour has become a more common worldwide medical intervention during the last few years [1]. The ideal cervical ripening agent must be effective, safe, easy to be administered and acceptable for the pregnant woman. Utilizing prostaglandins (PG) for cervical ripening during induction of labour (IOL) was first described in the 1960s [2]. Since that time various types of prostaglandins including PGF2α, PGE2 (Dinoprostone) and PGE1 (Misoprostol) were extensively studied to elicit the best prostaglandin pharmacological agent for pre-induction cervical ripening [2]. Dinoprostone was found to be superior to the others, as it increased the rates of successful vaginal delivery within 24 h without increasing the operative delivery rates. Vaginal route was found to be a safe and effective approach of bringing on labor.

A randomized clinical trial of Premaquick biomarkers versus transvaginal cervical length for pre-induction cervical assessment at term among pregnant women.

To compare Premaquick biomarkers (combined insulin-like growth-factor binding protein 1 and interleukin-6) and cervical length measurement via transvaginal ultrasound for pre-induction cervical evaluation at term among pregnant women. A randomized clinical trial of consenting pregnant women at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The women were randomized equally into Premaquick group (n = 36) and transvaginal ultrasound group (n = 36). The cervix was adjudged 'ripe' if the Premaquick test was positive or if the trans-vaginal measured cervical length was less than 28 mm. The primary outcome measures were the proportions of women who needed prostaglandin analogue for cervical ripening and the proportion that achieved vaginal delivery after induction of labour. The trial was registered in Pan African clinical trial registry (PACTR) registry with approval number PACTR202001579275333. The baseline characteristics were similar between the two groups (p > 0.05). There was no statistically significant difference between the two groups in terms of proportion of women that required prostaglandins for pre-induction cervical ripening (41.7 versus 47.2%, p = 0.427), vaginal delivery (77.8 versus 80.6%, p = 0.783), mean induction to delivery interval (22.9 ± 2.81 h versus 24.04 ± 3.20 h, p = 0.211), caesarean delivery (22.2 versus 19.4%, p = 0.783), proportion of neonate with birth asphyxia (8.30 versus 8.30%, p = 1.00) and proportion of neonate admitted into special care baby unit (16.7 versus 13.9%, p = 0.872). Subgroup analysis of participants with 'ripe' cervix at initial pre-induction assessment showed that the mean induction to active phase of labour interval and mean induction to delivery interval were significantly shorter in Premaquick than transvaginal ultrasound group. Pre-induction cervical assessment at term with either Premaquick biomarkers or transvaginal ultrasound for cervical length is effective, objective and safe with similar and comparable outcome. However, when compared with women with positive transvaginal ultrasound at initial assessment, women with positive Premaquick test at initial assessment showed a significantly shorter duration of onset of active phase of labour and delivery of baby following induction of labour.

Moving preinduction cervical ripening to a lower acuity inpatient setting using the synthetic hygroscopic cervical dilator: a cost-consequence analysis for the United States

Background Leveraging the safety profile of the synthetic hygroscopic cervical dilator (SHCD), one potential way to reduce the burden-of-care provision in the labor-and-delivery unit without compromising safety is to introduce a low-acuity care room (ripening room) for patients undergoing cervical ripening as a part of labor induction at term. Methods Implementing a ripening room using SHCDs was compared to scenarios using prostaglandins including a dinoprostone insert (PGE2 insert) or gel (PGE2 gel) and misoprostol given orally (oral PGE1) or vaginally (vaginal PGE1). A theoretical, cost-consequence model was developed to assess costs, staff time, and selected clinical outcomes related to cervical ripening. The model assessed a hypothetical cohort where patients remained in hospital from admission for induction of labor (IOL) to delivery, taking the US labor-and-delivery unit perspective. Model inputs were taken from structured searches of PubMed and ClinicalTrials.gov, published US guidance, and clinical practice. Results are presented as mean (95% credible interval [CrI]). Results The ripening room using SHCDs cost US$3,210 and required 10.22 hours (h) of nurse time on average per patient. The cost difference to prostaglandins ranged from −$894 (−$2,269 to $398) for PGE2 gel to +$460 (−$1,467 to $1,539) for vaginal PGE1. Mean nurse time was shorter than all prostaglandins, with time savings ranging from −7.05 (−24.55 to 5.73) h for PGE2 insert to −0.97 (−14.69 to 9.59) h for vaginal PGE1. When outcomes of the probabilistic sensitivity analysis were ranked from 1 (best) to 5 (worst), the ripening room using SHCDs ranked 1.94 for costs and 1.97 for nurse time. In a nulliparous population, results improved for the ripening room using SHCDs relative to all prostaglandins. Conclusion In this theoretical study, implementing a ripening room using SHCDs resulted in the lowest time burden and the second lowest costs. The cheapest option for preinduction cervical ripening was vaginal misoprostol.

Comparison of Efficacy of Trans-Cervical Foleys Catheter and PGE2 Gel for Induction of Labour

Background: Induction of labour is initiation of uterine contractions before the onset in order to vaginally deliver the fetoplacental unit. Common reasons for induction of labour (IOL) are post-term and hypertensive disorders of pregnancy. Many women who undergo induction do not have a favourable cervix, so some methods of cervical ripening either pharmaceutical or mechanical are used. Aim &amp; Objective: To compare the effectiveness of the transcervical Foley catheter and the prostaglandin E2 (PGE2) gel for the induction of labour. Methodology: The clinical trial was conducted for a period of two years OBGY department of Bharati Vidyapeeth University, Pune. 196 pregnant women which included and randomly via block randomization divided into two groups. Group A had 98 women in whom the transcervical Foley catheter was inserted and Group B included 98 women in whom the PGE2 gel was inserted vaginally for IOL. Bishop’s score and duration from induction to onset of labour was calculated. Data analysis was done and appropriate statistical tests were used. Results: In Group A (37.8%) as well as in Group B (41.8%) most of the pregnancies were primigravida. The most common indication for induction in both groups was postdatism. The adjuvant therapy was required in 66.3% and 54.1% of women in Group A &amp; B respectively. Significant higher median values were observed in Bishop’s score at 12 hours as compared to 0 hour in both the groups. No significant association was observed between mode of induction and need of adjuvant therapy and induction to onset hours in both groups. Conclusion: The study shows that both Foley's catheter and PGE2 gel are equally effective in pre induction cervical ripening.

Isonicotinic acid hydrazide (INH) versus extra-amniotic saline infusion (EASI) for cervical ripening at term: a randomised controlled trial

The purpose of this trial was to compare extra-amniotic saline infusion (EASI) and intravaginal isoniazid (INH) for cervical ripening. This randomised clinical trial included 150 pregnant women who were undergoing induction of labour and who required pre-induction cervical ripening. Patients were randomly assigned to receive EASI or intravaginal INH. Bishop’s score at the beginning of the study and before oxytocin infusion was not significantly different between INH and EASI groups. However, the time from first intervention to the beginning of the induction and also to the beginning of the active phase were significantly shorter in EASI group (p value ≤.001). Moreover, INH did not influence the labour process after the beginning of the active phase of labour. In conclusion, INH could be used for cervical ripening especially in the outpatient setting; however, it is a slower ripening agent compared to EASI. Impact Statement What is already known on this subject? To date there has been only one study about the safety and effectiveness of isoniazid (INH) in cervical ripening at term pregnancy which has compared INH with misoprostol. What do the results of this study add? The results of this study showed that vaginal INH is an effective agent for cervical ripening at term but in comparison to extra-amniotic saline infusion (EASI) it takes a longer time. What are the implications of these findings for clinical practice and/or further research? INH can be used in outpatient settings for cervical ripening at term pregnancy which makes it convenient for patient and cost effective for both patient and health system. Further studies are needed to discover the clinical efficacy of INH in comparison to other ripening methods and also the best dosage of INH for cervical ripening.

Efficacy of Mifepristone in Preinduction Cervical Ripening in Term Pregnancy

Efficacy of Mifepristone in Preinduction Cervical Ripening in Term Pregnancy

Comparision of intra cervical PGE2 gel and transcervical Foley’s catheter for pre-induction cervical ripening

Introduction: Induction of labour is a common obstetric intervention, occurring in approximately 25% of term pregnancies in developing countries. Pharmacological and mechanical methods commonly used are prostaglandin preparations (PGE1 and PGE2) and various intracervical catheters (single or double balloon), respectively. Material and methods: Study was conducted in Siliguri District Hospital, Siliguri, Darjeeling, west Bengal. 100 antenatal woman admitted in obstetrics ward with pog more than 37 weeks were taken for study after applying inclusion and exclusion criteria. 50 were induced with cerviprime gel and 50 with intracervical foley catheter. Statistical analysis done. Results: Mean interval between treatment initiation and delivery was not statistically significant, tachysystole was more common in group B women, rate of LSCS and NVD was similar in both groups. Conclusion: It can be concluded from the present study that Foley’s catheter (mechanical) and prostaglandin E2 gel [pharmacological] both are effective agents for preinduction cervical ripening which substantially improve the bishops score and increase the chances of successful labour induction. There is no significant difference in their efficacy, mode of delivery and perinatal outcome.

TO DETERMINE THE EFFICACY AND SAFETY OF MIFEPRISTONE USE FOR CERVICAL RIPENING AND INDUCTION OF LABOUR VS EXPECTANT MANAGEMENT IN TERM AND POST TERM PREGNANCY IN NMCH PATNA, BIHAR

Background :To study the effect of mifepristone in cervical ripening and induction of labour to facilitate normal vaginal delivery. Aims and objectives: This study was done on use of mifepristone for pre induction cervical ripening and labour induction in terms of safety, efcacy and feto maternal outcome. Material and method: 100 women near term and post term pregnancy with poor bishop score less than 4 were randomised in study group and 100 women were kept in control group (expectant management) and augmentation was done in both groups after improvement in Bishop's score. Observation and result: preinduction cervical ripening was successful in76% of patients receiving mifepristone. Induction delivery interval was reduced and vaginal delivery was more in mifepristone group. Conclusion: Mifepristone can be used for pre induction cervical ripening in term and post term pregnancy with reduced induction delivery interval and good fetomaternal outcome.

Comparative study between mifepristone and dinoprostone gel for cervical ripening and induction of labour

Induction of labor is common in obstetric practice. According to the most current studies, the rate varies from 9.5 to 33.7 percent of all pregnancies annually. Cervical ripening is necessary for a successful vaginal delivery. This study shows shorter labour stages I and III, and less blood loss in mifepristone group. The drug has no significant effects on uterine contraction and no serious maternal complications. This drug has a safe neonatal outcome. Patient can remain ambulatory, which is very convenient as compared to PGE2 gel. PgE2 gel needs refrigerator for storage and skill for intracervical insertion with strict aseptic technique. Hence mifepristone offers advantages over PGE2 gel which is currently used for preinduction cervical ripening.

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.

Pre-Induction Cervical Ripening: A Prospective and Comparative Study of Intra-Cervical Foley’s Catheter and Prostaglandin E2 Gel

Background: Cervical ripening essentially refers to the process of softening the cervix in order to make it prepare for the induction of labor. The success of labor induction depends on the cervical status at the time of induction. There are various methods of cervical ripening; however, in this study we will compare two famous methods of cervical ripening; Foley’s cervical catheter and PGE2gel. Method: This prospective study was conducted at Lala-Ded Hospital, Srinagar from March 2016- September 2017. A total of 70 women fulfilling the defined inclusion criteria were enrolled for this study. They were randomly distributed into 2 groups, Group 1 (Foley’s catheter group) and Group 2 (PGE2 gel group) with 35 women included in each group. Patients at term with various indications for induction of labor were included in the study after a comprehensive written consent. Result: The age distribution between the groups was insignificant. We observed that average gestational age was comparable in both the groups with a p-value of 0.526. However, the average post induction Bishop’s score was significantly higher in group 1 compared to group 2with a p-value of 0.034. Conclusion: The present study demonstrated that even though both the methods of cervical ripening are effective but with Foley’s intra-cervical catheter we witnessed a shorter induction delivery interval in comparison to PGE2 gel. Moreover, there was significant improvement in Bishop’s score with Foley’s catheter. Therefore, we suggest that in developing countries with limited resources Foley catheter is the optimal choice for pre induction cervical ripening in terms of cost effectiveness and attaining the desired results. Keywords: Cervical ripening, pre labor induction, Foley’s cervical catheter, PGE2 gel.