Preinduction Cervical Ripening Research Articles

Cervico-vaginal foetal fibronectin: A predictor of cervical response at pre-induction cervical ripening

Not all pregnant women with an "unripe" cervix can be successfully ripened by the cervical ripening agents; therefore tests with predictive information are justified. To examine the effect of the presence of foetal fibronectin (FFN) in the cervico-vaginal secretions on pre-induction cervical ripening with either intravaginal Misoprostol or transcervical Foley catheter. Twenty (20) patients managed at a tertiary health institution in South-western Nigeria between March and May 2003 were randomised for cervical ripening by either intravaginal Misoprostol or Transcervical Foley catheters. Cervico-vaginal secretions were assessed for presence of FFN with Foetal Fibronectin Enzyme Immunoassay Kit (Adeza Corp.) prior to commencement of cervical ripening. FFN status, Pre-ripening and Pre-induction modified Bishop scores and duration of cervical ripening. Ten of the fifteen patients with positive membrane immunoassay for FFN achieved ripened cervix (modified Bishop score > or = 6) within 6 - 12 hours of exposure to the agents of cervical ripening. In the FFN negative group, only 2 of the five patients achieved ripe cervix within the >12 - 18 hours period, the rest being in the >18 - 24 hours period. Foetal fibronectin test may offer useful predictive information prior to institution of processes of cervical ripening in patients with unfavourable cervices.

Comparison of Labor Progression Between Induced and Noninduced Multiparous Women

The incidence of labor induction is rising rapidly in the United States. Among multiparas, labor is often followed with traditional labor curves derived from noninduced pregnancies. We sought to determine how labor progression of multiparous women who presented in spontaneous labor differed from those who were electively induced with and from those induced without preinduction cervical ripening. We analyzed data on all low-risk multiparous women with an elective induction or spontaneous onset of labor between 37(+0) and 40(+6) weeks of gestation from January 2002 to March 2004 at a single institution. The median duration of labor by each centimeter of cervical dilatation and the risk of cesarean delivery were computed for 61 women with preinduction cervical ripening and oxytocin induction, 735 women with oxytocin induction, and 1,885 women with a spontaneous onset of labor. An intracervical Foley catheter was used to ripen the cervix. Those women who experienced electively induced labor without cervical ripening had a shorter active phase of labor than did those admitted in spontaneous labor (99 minutes in induced labor versus 161 minutes in spontaneous labor, P < .001). However, the cesarean delivery rate was elevated in the induction group (3.9% versus 2.3%, P < .05). Women who underwent preinduction cervical ripening also had a shorter active phase than those admitted in spontaneous labor (109 minutes versus 161 minutes, P = .01). The pattern of labor progression differs for women with an electively induced labor without cervical ripening compared with those who present with spontaneous onset of labor.

Intravaginal misoprostol versus transcervical Foley catheter in pre-induction cervical ripening

Cervical status undoubtedly correlates closely with the success of induction of labor and studies have shown the benefits of prostaglandin preparations in pre-induction cervical ripening and labor induction. Misoprostol (Prostaglandin E1 analogue) has a long shelf-life even in tropical climates. Undoubtedly intravaginal misoprostol has advantages over transcervical Foley catheter in pre-induction cervical ripening. This report outlines the three cervical factors -- length consistency and dilatation -- responsible for the comparative advantage of intravaginal misoprostol above the transcervical Foley catheter in pre-induction cervical ripening. (excerpt)

Fetal Fibronectin as a Predictor of Vaginal Birth in Nulliparas Undergoing Preinduction Cervical Ripening

We sought to evaluate whether the presence of a positive fetal fibronectin (> or = 50 ng/mL) in nulliparous women undergoing preinduction cervical ripening with the intracervical Foley catheter predicted vaginal birth. This was a prospective blinded observational trial of nulliparous women undergoing preinduction cervical ripening. We excluded women who had a contraindication to vaginal birth. Cervical and vaginal fetal fibronectin specimens were obtained before preinduction cervical ripening with an intracervical Foley catheter. The managing obstetrician was blinded to these results. A total of 241 women met the inclusion criteria, of which 54.4% delivered vaginally. There was no difference in the rate of vaginal delivery among women with either a positive cervical fetal fibronectin (positive fetal fibronectin 55.8% compared with negative fetal fibronectin 53.3%, P = .70) or positive vaginal fetal fibronectin (positive fetal fibronectin 57.6% compared with negative fetal fibronectin 53.3%, P = .56). Women with a positive cervical fetal fibronectin did have a shorter duration of cervical ripening (fetal fibronectin-positive 229 +/- 220 minutes compared with fetal fibronectin-negative 379 +/- 193 minutes, P < .05), duration of oxytocin (fetal fibronectin-positive 655 +/- 555 minutes compared with fetal fibronectin-negative 731.5 +/- 342 minutes, P < .025) and required lower maximal doses of oxytocin (fetal fibronectin-positive 18.4 mIU/min compared with fetal fibronectin-negative 21.8 mIU/min, P = .005). Women with a positive vaginal fetal fibronectin demonstrated only a shorter duration of cervical ripening compared with their fetal fibronectin negative counterparts (fetal fibronectin-positive 300 +/- 216 minutes compared with fetal fibronectin-negative 345 +/- 201 minutes, P < .05). Fetal fibronectin does not predict vaginal delivery in nulliparous women requiring preinduction cervical ripening. II-2.

Evaluation of glyceryl trinitrate, misoprostol, and prostaglandin E2 gel for preinduction cervical ripening in term pregnancy

To compare the efficacy of glyceryl trinitrate (GTN), dinoprostone and misoprostol for preinduction cervical ripening in primigravida at term. Sixty-five term primigravida, each with an unfavorable cervix (Bishop score </=5), were randomized to receive GTN (0.5 mg perivaginally, n = 21), dinoprostone gel (0.5 mg intracervically, n = 21) and misoprostol (50 microg perivaginally, n = 23) for a maximum of two doses, 6 h apart. Statistical analysis included paired t-tests to compare pre- and post-treatment Bishop scores, one-way analysis of variance (anova) tests to compare quantitative variables and chi-squared tests to compare the proportion of subjects achieving favorable Bishop scores. Baseline Bishop scores were similar in the GTN (3.4 +/- 0.9), dinoprostone (3.4 +/- 1.0) and misoprostol groups (3.2 +/- 1.2). The final outcome was favorable (Bishop score >6) in a greater proportion of subjects in the misoprostol (n = 18, 81.8%) and dinoprostone (n = 14, 66.7%) groups compared with the GTN group (n = 11, 55%). In subjects with a severely unfavorable cervix (Bishop score </=3), treatment with misoprostol led to a favorable response in 61.6% of patients compared with 45.6% in the misoprostol group and 33.3% in the GTN group. A significant improvement was noted in the Bishop score of all three groups (P < 0.001) but the increase in Bishop score was greater in misoprostol (3.5 +/- 2.1) and dinoprostone groups (2.8 +/- 1.5), compared with the GTN group (2.0 +/- 1.0, ANOVA F = 4.8, P = 0.01). Hyperstimulation and tachysystole were observed only in the misoprostol (9% and 4.3%) and dinoprostone groups (4.7% and 16.2%). The most common adverse effect in the GTN group was headache, which was observed in 47.6% of this group's subjects. The findings of the present study suggest that GTN is safer, but less efficacious, compared with prostaglandins for preinduction cervical ripening at term.

Labor Progression and Risk of Cesarean Delivery in Electively Induced Nulliparas

To describe the pattern of labor progression and risk of cesarean delivery in women whose labor was electively induced. We analyzed data on all low-risk, nulliparous women with an elective induction or spontaneous onset of labor between 37 + 0 and 40 + 6 weeks from January 2002 to March 2004 at a single institution. The median duration of labor by each centimeter of cervical dilation and the risk of cesarean delivery were computed for 143 women with preinduction cervical ripening and oxytocin induction, 286 women with oxytocin induction, and 1,771 women with a spontaneous onset of labor. An intracervical Foley catheter was used to ripen the cervix. Electively induced labor with cervical ripening had substantially slower latent and early active phases. After controlling for potential confounders, women who had an elective induction with cervical ripening had 3.5 times the risk of cesarean delivery during the first stage of labor (95% confidence interval 2.7-4.5), compared with those admitted in spontaneous labor. Elective induction without cervical ripening, on the other hand, was associated with a faster labor progression from 4 to 10 cm (266 compared with 358 minutes, P < .01) and did not increase the risk of cesarean delivery, compared with those in spontaneous labor. The pattern of labor progression differs substantially for women with an electively induced labor compared with those with spontaneous onset of labor. Furthermore, elective induction in nulliparous women with an unfavorable cervix has a high rate of labor arrest and a substantially increased risk of cesarean delivery. II-2.

Comparison of extraamniotic Foley catheter and intracervical prostaglandin E2 gel for preinduction cervical ripening

The success of induced labor depends on the degree of ripening of cervix. Pharmacological preparations are in widespread use for cervical ripening but are not free from side-effects and complications. Mechanical methods, i.e. the use of Foley catheter balloon, though effective have not gained much popularity because of the fear of infection. Therefore, this study has been conducted to prove the efficacy and safety of extraamniotic Foley catheter balloon and to compare it with intracervical prostaglandin E2 (PGE2) gel. The randomized prospective study was conducted in the Department of Obstetrics and Gynecology and Medical Microbiology of Nehru Hospital. Hundred women attending the labor ward for induction of labor were divided into two groups: Group A--Foley catheter, Group B--PGE2 gel. Cervical swabs before and after the insertion of ripening agents were taken for culture studies. Placental membranes were also sent for culture. Labor outcome, side-effects, and complications were compared in both the groups. The statistical methods used were Student's compared t-test, Chi-square test, and Wilcoxon-Mann-Whitney test. Foley catheter proved to be a very effective preinduction ripening agent for unfavorable cervix compared with PGE2 gel, as is evident by the mean Bishop score at 12 h (P<0.001). Preparation delivery interval was significantly shorter (P<0.05) in women who underwent cervical ripening with Foley catheter balloon than with the PGE2 gel. No clinical evidence of chorioamnionitis was present in both the groups. This study concludes that extraamniotic Foley catheter balloon is an effective, safe, simple, low-cost, reversible, non-pharmacological mechanical method of preinduction cervical ripening.

Outpatient Misoprostol Compared With Dinoprostone Gel for Preinduction Cervical Ripening: A Randomized Controlled Trial

To determine whether a single outpatient dose of intravaginal misoprostol (versus intracervical dinoprostone gel) reduces the oxytocin use for induction. Despite the numerous trials examining misoprostol for induction, the efficacy of a single outpatient dose of misoprostol followed by oxytocin induction is unknown. Patients with a term, vertex, singleton pregnancy and a Bishop score of 6 or less were randomly assigned to receive misoprostol (n = 42, 0.25 microg intravaginally) or dinoprostone gel (n = 42, 0.5 mg intracervically) the evening before oxytocin induction. Patients were monitored for 3 hours after administration and discharged to home if fetal assessment was reassuring, for readmission the next morning for oxytocin. Primary outcomes were oxytocin dose, time, and dose intensity (dose divided by duration). Secondary outcomes were incidence of labor, uterine hyperstimulation, cesarean delivery, Apgar score. Statistics used were chi(2), Student t test, Mann-Whitney rank sum test, and Fisher exact test. P < .05 was accepted as statistically significant. A single dose of misoprostol significantly decreased the cumulative dose of oxytocin, the cumulative time of oxytocin administration, and the dose intensity of oxytocin (dose divided by time). Data are as follows (mean +/- standard error of the mean): oxytocin dose-dinoprostone 10,929 +/- 219 mU, misoprostol 6,081 +/- 170 mU, P = .008; oxytocin time-dinoprostone 798 +/- 11 minutes, misoprostol 531 +/- 11 minutes, P = .009; dose intensity-dinoprostone 11.3 +/- 0.1 mU/min, misoprostol 7.4 +/- 0.2 mU/min, P = .003. Misoprostol induced labor during the ripening period in 19 of 41 of patients, compared with 6 of 42 after dinoprostone (P = .002). There was no difference in cesarean delivery (dinoprostone, 8/42; misoprostol, 9/42; P = 1.00). There was no difference in short-term neonatal outcome. No patient had hyperstimulation or required cesarean delivery for nonreassuring fetal assessment during the ripening period. A single dose of misoprostol administered in the outpatient setting significantly decreases oxytocin use, largely due to labor within the ripening period.

Uterine Rupture in Patients With a Prior Cesarean Delivery: The Impact of Cervical Ripening

The risk of uterine rupture after vaginal birth after cesarean delivery (VBAC) is small, but the consequent maternal and fetal morbidity is potentiality very serious. The investigators sought to identify factors associated with uterine rupture in 972 attempts at VBAC made by 936 women at a single institution in the years 1996-1999. Six attempts involved twin gestations. Vaginal delivery took place in 72% of cases. There were 33 uterine ruptures at the site of previous cesarean delivery (3.4%). All but 5 ruptures were symptomatic. Two ruptures were in women having 2 past cesarean deliveries. There were no differences between the women with and those without uterine rupture in mean gestational age. Women having a successful VBAC previously were less likely to have a symptomatic uterine rupture. Induction was more frequent in patients with uterine rupture, and they were much likelier to have undergone cervical ripening before induction. The odds ratio (OR) for symptomatic rupture after preinduction cervical ripening was 3.92. When a Foley catheter was used for preinduction cervical ripening, the OR for uterine rupture was 3.67. All ruptures in women having preinduction cervical ripening developed uterine rupture during active labor. Women having preinduction cervical ripening were significantly less likely than other women to deliver vaginally (46.7% vs. 76.95%). Al but 2 women with uterine rupture were delivered by cesarean section. The only intrapartum fetal death occurred in a woman with symptomatic uterine rupture who had fetal expulsion at the time of emergency cesarean delivery. Apgar scores at 1 minute, but not at 5 minutes, were lower in cases of symptomatic uterine rupture. Fetuses born after symptomatic uterine rupture were likelier to be admitted to neonatal intensive care. No woman required a blood transfusion or hysterectomy. Women attempting VBAC have a high rate of symptomatic uterine rupture after preinduction cervical ripening, and the risk-benefit ratio would seem to discourage this practice. This is especially the case when considering the low rate of successful vaginal delivery. Women must know of the risks involved, and elective repeat cesarean delivery should be carefully considered as an effective alternative to VBAC.

Randomised trial of intravaginal misoprostol and intracervical Foley catheter for cervical ripening and induction of labour

SummaryInduction of labour may be indicated despite an unripe cervix. The purpose of this study was to compare the safety and efficacy of intravaginal misoprostol and an intracervical Foley's balloon catheter for preinduction cervical ripening and labour induction. A total of 120 patients requiring indicated induction of labour with an unfavourable cervix (Bishop's score ≤4) were randomised prospectively to receive either 50 μg intravaginal misoprostol every 6 h for a maximum of two doses, or an intracervical Foley balloon catheter for 12 h followed by an intravenous oxytocin infusion. The two arms of the study were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop's scores. There were significant change in the Bishop's score in the two groups (5.9 ± 0.2 and 4.0 ± 0.2, respectively, p < 0.001) but no inter group differences. Oxytocin induction or augmentation of labour occurred more in the catheter group (95%) than in the misoprostol group (43.3%) (p < 0.0001). Induction to delivery interval was significantly shorter in the misoprostol group than in the catheter group (8.7 ± 2.4 vs 11.9 ± 2.7 h p < 0.0001). There was no significant difference noted in the caesarean or other operative delivery rates among patients in the two treatment groups. There was a higher incidence of tachysystole and hyperstimulation in the misoprostol group than in the catheter group (p < 0.03). No differences were observed between groups for meconium passage, 1- or 5-min Apgar scores <7 and admission into the neonatal intensive care unit. In conclusion, the maternal and perinatal outcomes in this study have shown no difference confirming the efficacy and safety of both methods, however we observe a decrease in the induction-to-delivery interval when misoprostol is used for this purpose.

Comparison of two preparations of dinoprostone for pre-induction of labour in nulliparous women with very unfavourable cervical condition: a randomised clinical trial

The aim of this study was to compare the clinical effects of preinduction cervical ripening by using two ways of dinoprostone administration. In a prospective, open-label trial, 144 consecutive nulliparous women with a Bishop score <4 who required induction of labour at term were randomised to receive dinoprostone via either a vaginal insert (10 mg over 12 h) or a cervical gel (0.5 mg, twice in 12 h). If labour did not start by 24 h after this preinduction, patients received 2 mg vaginal dinoprostone gel followed 6 h later by oxytocin infusion. The main outcome measure was the rate of caesarean sections (CS). Secondary measures were: changes in Bishop score at 6 h and 12 h, delivery within 12 h and 24 h, need for oxytocin for induction, failure of induction (delivery after >48 h), need for pharmacological interventions to manage tachysystole/hyperstimulation, length of stay in hospital. The CS rate was lower in the vaginal insert group (22.9%) than in the cervical gel group (34.3%), though the difference did not reach statistical significant difference ( P = 0.13). The indications for CS overlapped between the groups. The rate of vaginal delivery within 12 h and 24 h was similar, as was the rate of failure of induction. More women in the gel group (41.4% versus 24.3%) required the use of oxytocin (OR = 2.21; 95% CI = 1.07–4.55). Tachysystole or hyperstimulation in the vaginal insert group (7) was twice that with cervical gel (4). Four women in the vaginal insert group and three in the cervical gel group reported infectious complications. A long stay in hospital (>4 days) was less frequent with vaginal inserts (21.4 versus 38.6%; OR = 0.43, 95% CI = 0.19–0.97). The more challenging preinductions of labour at term are associated with increased obstetric interventions such as a high CS rate and a more frequent requirement for oxytocin inductions. In terms of success and failure, vaginal inserts releasing dinoprostone do not differ from dinoprostone given by the traditional cervical route. However, the use of vaginal inserts reduces the need for obstetric interventions and allows shorter periods in hospital.

A randomized trial comparing a 30-mL and an 80-mL Foley catheter balloon for preinduction cervical ripening

Objectives The purpose of this study was to compare the efficacy of cervical ripening with 2 Foley catheter balloon volumes. Study design Pregnant women admitted for induction of labor with a term singleton gestation were randomly assigned for cervical ripening by a balloon inflated with 30 mL or 80 mL of sterile saline. Results Two hundred and three women were included in the analysis. Ripening of the cervix with the larger balloon volume was associated with a significantly higher rate of post-ripening dilatation of 3 cm or more (76.0% vs 52.4%, P < .001). In primiparous women, the larger balloon volume resulted in a significantly higher rate of deliveries by 24 hours (71.4% vs 49%, P < .05), and a significantly less requirement of augmentation with oxytocin (69.3% vs 90.4%, P < .05). Conclusion Ripening of the unfavorable cervix in primiparous women with a Foley catheter balloon inflated with 80 mL provided effective more dilatation, faster labor, and decreased need for oxytocin than with a balloon inflated with 30 mL of sterile saline.

Uterine rupture in patients with a prior cesarean delivery: the impact of cervical ripening.

The purpose of this study was to examine factors that were associated with uterine rupture in patients attempting vaginal birth after cesarean delivery. We analyzed the results of all patients attempting vaginal birth after cesarean delivery between September 1996 to December 1999 at a single institution using a contemporaneously maintained registry. Maternal factors, fetal factors, and management of labor were all assessed to determine the risk factors associated with symptomatic uterine rupture at the time of attempted vaginal birth after cesarean delivery. Twenty-eight symptomatic ruptures were identified in 972 attempts of vaginal birth after cesarean delivery at a gestational age greater than 24 weeks (2.88%). The use of preinduction cervical ripening was significantly associated with an increased risk of symptomatic uterine rupture (odds ratio, 3.92; 95% confidence interval, 1.78 to 8.62). Patients who underwent preinduction cervical ripening were significantly less likely to delivery vaginally than women who had not (46.71 versus 76.87%; p < 0.001). No other differences were noted between the two groups. Preinduction cervical ripening is associated with an increased risk of uterine rupture in women attempting vaginal birth after cesarean delivery.

Preinduction cervical ripening with the Foley catheter and the risk of subsequent preterm birth

Objective The Foley catheter is a safe and effective form of preinduction cervical ripening and is quickly growing in popularity. Its major effect appears to be through mechanical dilation, which has raised the concern that the use of the Foley catheter for cervical ripening may damage the cervix and result in a higher rate of subsequent preterm birth. Study design We conducted a review of all induction of labor at our institution from July 1998 to July 2001 that required preinduction cervical ripening and had a subsequent birth. The primary outcome variable was preterm birth at <35 weeks of gestation. Demographic and potential confounding variables were analyzed. A probability value of <.05 was considered significant. Results The cases of 126 women (63 women in the Foley group and 63 women in the prostaglandin group) were studied. Women in the prostaglandin group had a prostaglandin agent used. There was no difference in maternal age, gravidity, parity, Bishop score, total time of induction, gestational age, oxytocin use, maximum oxytocin level, tobacco or drug use, or type of delivery in the index pregnancy between the groups. In the subsequent pregnancies, there were no differences in maternal age, gravidity, parity, spontaneous abortions, terminations, cone or Loop Electrosurgical Excision Procedure (LEEP) procedures, history of cervical manipulation, tobacco or drug use, stillbirth, need for induction, mode of delivery, episiotomy, gestational age at delivery, Apgar scores, labor duration, use of oxytocin, or birth weight. There were no differences in preterm birth at 37, 35, or 32 weeks of gestation between the groups. Conclusion The use of the Foley catheter for preinduction cervical ripening does not appear to increase the risk of preterm birth in a subsequent pregnancy.

Low dose intravaginal misoprostol versus intracervical balloon catheter for pre-induction cervical ripening

The efficacy and safety of low dose misoprostol as a ripening agent compared to the widely used balloon catheter in developing countries is undetermined. To compare the safety and efficacy of a low dose intravaginal misoprostol and intracervical Foley's catheter for cervical ripening. A prospective randomized controlled trial. Zonal General Hospital, Kwale, Nigeria from June 1, 1998 to May 30, 2001. Candidates for pre-induction cervical ripening were randomized to receive either 250 mcg of intravaginal misoprostol every four hours (n = 60) or intracervical Foley's catheter (n = 61). Failure to achieve cervical ripening within 24 hours, need for augmentation, maternal and foetal complications. Failure to achieve cervical ripening within two hours was reduced with misoprostol (Relative Risk [RR] 0.63, 95% Confidence Interval [CI] 0.43 - 0.92). Need for oxytocin augmentation was less in the misoprostol group (RR 0.76, 95% CI 0.64 to 0.91). No significant differences existed in rates for uterine hyperstimulation, Caesarean section, maternal and neonatal morbidity. Intravaginal misoprostol in a low dose was compared to intracervical balloon catheter for pre-induction ripening of the cervix.

A comparison of labor curves between induced and non-induced multiparous women

INDUCED MULTIPAROUS WOMEN MATTHEW HOFFMAN, ANTHONY SCISCIONE, ANJEL VAHRATIAN, JAMES TROENDLE, JUN ZHANG, Christiana Hospital, Newark, DE None Given, Newark, DE University of North Carolina at Chapel Hill, Maternal and Child Health, Bethesda, MD National Institutes of Health, Epidemiology Branch, Bethesda, MD OBJECTIVE: The incidence of labor induction is rising rapidly in the United states. The labor in these women is often followed with traditional labor curves derived from uninduced pregnancies. We sought to determine how the labor curves of women who presented in spontaneous labor differed from those who were electively induced with and without pre-induction cervical ripening. STUDY DESIGN: We studied the labor curves of all multiparous women with a singleton vertex fetus between January 2002 and June 2003 at a single institution. We excluded women who had diabetes, contraindications to vaginal delivery or othermaternal/fetal indications for delivery. For the analysis, women were categorized as spontaneous labor(LABOR), electively induced(INDUCED) or induced with pre-induction cervical ripening(RIPENING). Labor curves were generated using interval censored regression after adjusting for confounders. RESULTS: Two thousand and seventy women were included in the study(66% LABOR, 30% INDUCED, and 4% RIPENING). Patient characteristics are presented in Table 1 and labor progression in Table 2. CONCLUSION: Compared to women in spontaneous labor, women who were induced without pre-induction cervical ripening had a shorter active phase. In contrast, women who underwent pre-induction cervical ripening had a slower latent phase and similar active phase when compared to those in spontaneous labor.

A comparison of oral mifepristone to intravenous oxytocin for pre-induction cervical ripening and labor induction in women with prelabor rupture of membranes beyond 36 weeks' gestation

A comparison of oral mifepristone to intravenous oxytocin for pre-induction cervical ripening and labor induction in women with prelabor rupture of membranes beyond 36 weeks' gestation

A prospective randomized controlled trial that compared misoprostol, Foley catheter, and combination misoprostol–Foley catheter for labor induction

Objective The purpose of this study was to determine the efficacy of combination intravaginal misoprostol and intracervical Foley catheter for prelabor cervical ripening. Study design A prospective, randomized controlled trial was conducted. Women who were undergoing labor induction, with a singleton gestation ≥28 weeks and an unfavorable cervix (Bishop score ≤6), were assigned to one of three groups: (1) intravaginal misoprostol 25 μg every 3 hours, (2) intracervical 16F Foley catheter, or (3) combination misoprostol–Foley catheter. Results Among 146 patients, 49 patients were assigned to misoprostol, 54 patients were assigned to Foley catheter, and 43 patients were assigned to combination therapy. There was no difference in vaginal delivery rates (misoprostol, 63.3%; Foley, 57.4%; combination, 58.1%; P = .81). There were also no statistically significant differences in the interval between induction to active phase, active phase to delivery, or induction to delivery among the three groups. Conclusion Intravaginal misoprostol and intracervical Foley catheter are comparable for preinduction cervical ripening. The combination of the two methods did not provide additional efficacy.

Intracervical Foley catheter balloon vs. prostaglandin in preinduction cervical ripening

Objectives: The aim of this study is to compare the effectiveness of the intracervical Foley balloon catheter and 3 mg prostaglandin E 2 tablet(s) in preinduction cervical ripening. Methods: Ninety women referred to the maternity clinic for induction of labor with a Bishop score of less than or equal to 5 were randomized to receive an intracervical Foley catheter or prostaglandin E 2 tablets. The primary measured outcome was ripening of the cervix as measured with the Bishop score. Results: There were no differences in mean Bishop scores between the prostaglandin and the Foley catheter groups. Bishop scores (mean±S.D.) after ripening were 6.6±0.80 and 6.7±0.86 for the Foley catheter and prostaglandin groups, respectively ( P=0.54). The Foley catheter group showed a statistically shorter time to ripening compared with the prostaglandin group (3.4±2.1 and 6.5±3.2 h, respectively ( P=0.001). There was no statistically significant difference in induction time (4.8±1.8 h and 5.3±2.4 h, respectively ( P=0.36). Conclusions: There are no differences in preinduction cervical ripening efficacy between prostaglandin E 2 and the Foley catheter, but the Foley catheter has the advantage of ripening an unfavorable cervix in a shorter time.

Preinduction cervical ripening: basis and methods of current practice.

The rate of women undergoing labor induction is increasing, primarily because of patient-physician preferences. The widespread availability of preinduction cervical ripening agents has contributed to this rising trend. Approximately half of all women undergoing an induction of labor will have an unfavorable cervix that will require some ripening agent. Pharmacologic and mechanical dilator techniques have been proven to ripen the unfavorable cervix. A topically applied prostaglandin product, containing either dinoprostone or misoprostol, is the most popular means to soften and dilate the cervix. Any uterine hyperstimulation may be reversed by administering a tocolytic drug and, if possible, by removal of the ripening agent. A minimum trial of adequate labor is necessary before considering the induction to be a failure. Cesarean delivery rates may be higher and the length of hospital stay more prolonged. Careful consideration about the need for labor induction is recommended until prospective clinical trials can better validate marginal reasons for cervical ripening.