Abstract:
Background: Post term pregnancy is one of the common indications of induction of
labor in contemporary obstetric practice. However, the majority of women with post term
pregnancy have unfavourable cervices. Therefore, it is mandatory to achieve cervical
ripening in this group of women before proceeding to labor induction. These cervical
ripening methods often result in onset of labor which makes them also labor inducing
agents. Among the available various cervical ripening methods Foley catheter and
vaginal misoprostol are widely used in low income countries as they are relatively
inexpensive, available and effective. Nevertheless, there is paucity of studies comparing
the effectiveness and safety of the aforementioned methods.
Thus, this study compared the effectiveness and safety of low dose vaginal misoprostol
with trans cervical Foley catheter for cervical ripening and induction of labor in post
term pregnant women.
Methods: - The study was conducted from January to December 2014 at Gandi
Memorial Hospital (GMH) and Felege Hiwot Referral Hospital (FHRH). Quasiexperimental study design was employed and 111 post term pregnant women were
enrolled to each group of cervical ripening methods. Foley catheter, number 18 gauge,
was inserted trans cervically and inflated with 50ml of normal saline in women of group I
at FHRH. Women in group II received 25µg of misoprostol vaginally every 6hrs for a
maximum of 2 doses at GMH. Oxytocin infusion began when an indication comes to
picture. Results were tabulated and statistically analysed.
Results: - Baseline obstetric variables such as gestational age and parity were not
statistically different in both groups. Maternal age was found to be statistically
significant (28.40 Vs 26.02 yrs; P = 0.000). Change in Bishop score is marginally
significant in favour of the Foley catheter group even after controlling for maternal age
(5.67 Vs 5.33; P = 0.040). Vaginal delivery within 24 hours and ripening to delivery
intervals were not statistically different in both groups. Rate of vaginal delivery was
found to be marginally significant being higher in the Foley catheter group (84.7% Vs
72.2%; P = 0.013). When stratified for parity, the significance was in multiparous
women (93.4% Vs 78.3%; P = 0.012). Need for oxytocin was significantly higher in the
Foley catheter group (75.7% Vs 43.2%; P < 0.0001).
