Misoprostol versus Foley catheter insertion for induction of labor in pregnancies affected by fetal growth restriction

• Published in: International journal of gynecology and obstetrics Vol. 129; no. 2; pp. 152 - 155
• Main Authors: Chavakula, Pearlin R, Benjamin, Santosh J, Abraham, Anuja, Londhe, Vaibhav, Jeyaseelan, Visalakshi, Mathews, Jiji E
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ireland Ltd 01.05.2015
• Subjects: Administration, Intravaginal; Adult; Cardiotocography; Cervix Uteri; Cesarean delivery; Drug Administration Schedule; Duration of labor; Female; Fetal growth restriction; Fetal Growth Retardation - therapy; Foley catheter; Humans; India; Induction of labor; Labor, Induced - methods; Labor, Obstetric - drug effects; Misoprostol; Misoprostol - administration & dosage; Obstetrics and Gynecology; Oxytocics - administration & dosage; Oxytocin; Pregnancy; Urinary Catheterization - methods; Uterine tachysystole; India; Cesarean delivery; Duration of labor; Oxytocin; Fetal growth restriction; Foley catheter; Misoprostol; Uterine tachysystole; Induction of labor
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2014.11.018

Abstract Objective To compare 25 μg of vaginal misoprostol with a Foley catheter for induction of labor (IOL) for fetal growth restriction. Methods A randomized controlled trial was conducted in a tertiary center in South India. Women with fetal growth restriction (n = 100) were randomized to be induced with three doses of vaginal misoprostol (25 μg) every 6 hours or with an intracervical Foley catheter, inserted 12 hours before rupture of membranes, and oxytocin if needed. The primary outcome was uterine tachysystole with fetal cardiotocography abnormalities. Secondary outcomes pertained to effectiveness, complications, and patient satisfaction. Results One woman in the misoprostol group and none in the Foley catheter group had uterine tachysystole. The duration of labor from IOL to delivery was similar in both groups ( P = 0.416). More women in the misoprostol group had a vaginal delivery within 12 hours (26.1% versus 5.6%; P = 0.005). Women induced with misoprostol were less likely to deliver by lower-segment cesarean delivery (15.2% versus 29.6%; P = 0.168) and to require oxytocin augmentation (60.9% versus 85.2%; P = 0.007). Complications were few in both group. Conclusion Few women had uterine tachysystole with cardiotocography abnormalities. Vaginal misoprostol at 25 μg was more effective than a Foley catheter for IOL in fetal growth restriction. Clinical Trials Registry India: CTRI/2014/02/004411.