Effectiveness And Safety Of Low Dose Vaginal Misoprostol Compared To Trans Cervical Foley Catheter For Cervical Ripening In Post Term Pregnant Women Admitted To Gandi Memorial Hospital, Addis Ababa And Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia, From January To December 2014.

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).