Foley catheter plus misoprostol versus misoprostol alone for labor induction

This is a nonblinded, block randomized, controlled trial that compared the association between transcervical Foley catheter/vaginal misoprostol 25 μg combination and vaginal misoprostol 25 μg alone in normal-risk and healthy pregnant women undergoing labor induction in the south of Brazil.

RESULTS:

A total of 230 patients with indications for labor induction were evaluated and classified into the “combined” group (Foley catheter plus misoprostol), consisting of 107 patients, and the “misoprostol” group (misoprostol only), consisting of 123 patients. The “combined” group was observed to have a shorter labor induction time (p=0.008). In addition, there was a lower need for misoprostol use for overall cervical ripening (p<0.001) and a lower relative risk of needing a second, third, or fourth misoprostol tablet in the “combined” group (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.71–0.91; RR 0.41; 95%CI 0.31–0.56; and RR 0.29, 95%CI 0.17–0.52, respectively) (p<0.001). No statistically significant difference was found in induction failure rate, cesarean section rate, or perinatal outcomes.

CONCLUSION:

A combination of methods leads to shorter labor induction, lower need for misoprostol doses, and lower risk of cesarean section, with no increase in the rate of perinatal complications. REBEC number is RBR-7xcjz3z.

KEYWORDS:
Labor; Induced labor; Misoprostol

	Intervention				p-value
	Combined (n=107)		Misoprostol alone (n=123)
	Mean	SD	Mean	SD
Maternal age	27.75	6.82	26.9	6.11	0.120
Parity^* * Nulliparity was found in 65% on the “misoprostol” group and 68% on the “combined” group (p=0.610).	1.75	1.111	2	1	0.538
Gestation (weeks)	41	0.22	40.89	0.32	0.155
Bishop index	2.14	1.25	2.32	1.66	0.242
Birthweight (g)	3419.02	393.05	3413.54	425.73	0.619

		Intervention				RR (95%CI)	p-value
		Combined (n=107)		Misoprostol alone (n=123)
		n	%	n	%
Induction failure
	No	104	97.2	120	97.6	1.0 (Reference)
	Yes	3	2.8	3	2.4	1.08 (0.48–2.43)	0.869
Misoprostol (doses)
	1	107	100	123	100	1.0 (Reference)
	2	79	73.8	113	91.9	0.80 (0.71–0.91)	<0.001
	3	33	30.8	92	74.8	0.41 (0.31–0.56)	<0.001
	4	12	11.2	47	38.2	0.29 (0.17–0.52)	<0.001
	>4	2	1.9	10	8.1	0.23 (0.52–1.03)	0.054
Mode of delivery
	Vaginal	88	82.2	103	83.7	1.0 (Reference)
	Cesarean section	19	17.8	20	16.3	1.09 (0.62–1.93)	0.762
Complications
	None	90	84.1	101	82.1	1.0 (Reference)
	Yes	17	15.9	22	17.9	0.92 (0.63–1.36)	0.821
	PPH	5	4.8	7^* * On one occasion, there was a concomitant PPH and Apgar score <7.	5.7	–	–
	Uterine hyperstimulation	0	0	1	0.8	–	–
	Abruptio placentae	0	0	1	0.8	–	–
	Apgar score <7	12	11.2	14^* * On one occasion, there was a concomitant PPH and Apgar score <7.	11.4	–	–
	NICU admission	0	0	4	3.2	–	–

	Intervention				p-value
	Combined (n=107)		Misoprostol alone (n=123)
	Median	Range	Median	Range
Misoprostol (doses)	2	6	3	7	<0.001
Maximum oxytocin dose (mUI/min)	5	32	4	32	0.456
Induction time (h)	10	33	12	22	0.008
Labor time (h)	5	8	16	35	0.051
Length of stay (h)	56	42	60	132	<0.001

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: liakarina@hotmail.com