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Jebmh.Com Original Research Article Jebmh.com Original Research Article INDUCTION OF LABOUR WITH FOLEY’S CATHETER VERSUS VAGINAL MISOPROSTOL AT TERM 1 2 3 4 5 Venkata Ramana Kodali , Padma Leela Kotipalli , Madhuri Ampilli , Naga Lalitha Kokkiligadda , Mitra Vinda Vayilapalli , Mounica Kollabathula6 1Assistant Professor, Department of Obstetrics and Gynaecology, Andhra Medical College, Visakhapatnam, Andhra Pradesh. 2Professor, Department of Obstetrics and Gynaecology, Andhra Medical College, Visakhapatnam, Andhra Pradesh. 3Postgraduate, Department of Obstetrics and Gynaecology, Andhra Medical College, Visakhapatnam, Andhra Pradesh. 4Postgraduate, Department of Obstetrics and Gynaecology, Andhra Medical College, Visakhapatnam, Andhra Pradesh. 5Postgraduate, Department of Obstetrics and Gynaecology, Andhra Medical College, Visakhapatnam, Andhra Pradesh. 6Postgraduate, Department of Community Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh. ABSTRACT BACKGROUND The incidence of induction of labour is raising worldwide with a rate of 20% to 30% in developed countries. At present, each method of induction of labour has its own merits and demerits. We studied the safety and efficacy of Foley’s catheter in induction of labour at term and compared its safety and efficacy with that of vaginal misoprostol. MATERIALS AND METHODS This is a case-control study conducted on 100 pregnant women planned for induction of labour at term with a Bishop’s score of ≤6. Women were randomly divided into two groups of 50 patients in each group. In group A, labour was induced with trans cervical Foley’s catheter and in women in group B labour was induced with 25 micrograms of intravaginal misoprostol 4th hourly up to maximum of 6 doses. Induction delivery intervals and fetomaternal outcomes were noted. RESULTS In group A (Foley’s catheter group) only 50% of women delivered before 24 hours whereas 94% of group B (Misoprostol group) delivered before 24 hrs. The induction to delivery interval in group B is significantly shorter compared to group A. The rate of vaginal delivery was 76% in group A versus 82% in group B. The rate of caesarean section due to failed induction was 58.4% in group A compared to 22% in group B. There were higher rates of APGAR ≤6, Meconium stained liquor and NICU admissions in group B compared to group A. CONCLUSION Intravaginal Misoprostol is associated with shorter induction to delivery interval compared to Foley’s catheter and higher rate of vaginal delivery in case of unripe cervix. Whereas trans-cervical Foley’s catheter is associated with lower incidence of hyperstimulation and may be a reasonable alternative for patients who are at increased risk of uterine rupture during labour. KEYWORDS Bishop’s Score, Prostaglandins, Induction of Labour, Foley’s Catheter, Misoprostol. HOW TO CITE THIS ARTICLE: Kodali VR, Kotipalli PL, Ampilli M, et al. Induction of labour with foley’s catheter versus vaginal misoprostol at term. J. Evid. Based Med. Healthc. 2019; 6(11), 886-892. DOI: 10.18410/jebmh/2019/187 BACKGROUND Induction of labour should be performed only when In developed countries, up to 25% of all deliveries at term there is a clear medical indication for it and the expected are involved with induction of labour. Induction of labour is benefits outweigh its potential harms. The most effective defined by the World Health Organization as initiation of method for inducing labour has not been established in labour by artificial means prior to its spontaneous onset at a medical literature. The ideal induction agent would result in viable gestational age with the aim of achieving vaginal a short induction to delivery without risk to fetus and with delivery in a pregnant woman. low rates of emergency caesarean section. The common indications for induction of labour are Financial or Other, Competing Interest: None. Postdated pregnancy, Pre labour rupture of membranes, Submission 23-02-2019, Peer Review 28-02-2019, Hypertensive disorders, Maternal medical complications like Acceptance 08-03-2019, Published 15-03-2019. Corresponding Author: Preeclampsia, Gestational diabetes mellitus, Fetal growth Dr. K. Padma Leela, restriction, Fetal demise, Oligohydramnios etc. The role of Department of Obstetrics and Gynaecology, cervical ripening in success of induction of labour is well King George Hospital, Andhra Medical College, Maharanipeta, Visakhapatnam- 530002, established. A score of 6 or less indicates an unfavourable Andhra Pradesh. cervix and may be an indication for cervical ripening to E-mail: [email protected] initiate labour. DOI: 10.18410/jebmh/2019/187 Various methods available for cervical ripening and induction of labour are Sweeping of membranes, intravenous J. Evid. Based Med. Healthc., pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 6/Issue 11/March 18, 2019 Page 886 Jebmh.com Original Research Article Oxytocin, intracervical application of Prostaglandins like Andhra Pradesh between February 2016 to October 2017. PGE2 Dinoprostone gel or PGE1 Tablet Misoprostol, 100 pregnant women during this period who presented with Mechanical methods like introduction of Transcervical Foley’s various indications for induction of labour, who were willing catheter. However, induction of labour itself, especially to participate in the study. applied at an inappropriate time, may increase the risk of perinatal morbidity and /or caesarean delivery. Inclusion Criteria One systematic review and network meta-analysis was All the pregnant woman, more than 18 years of age, with conducted to compare the use of Foley’s catheter, various indications for induction of labour. Furthermore, only misoprostol and dinoprostone for cervical ripening in labour singleton gestation with cephalic presentation with intact induction and the results showed that no method of labour membranes, a reassuring feral heart rate on induction revealed overall superiority when all outcomes cardiotocography and those with Modified Bishop’s Score of were considered.1 Vaginal misoprostol was considered the 6 or less were included in the study. most effective method of induction of labour, but was associated with high rate of hyperstimulation and fetal heart Exclusion Criteria rate changes and not recommended for women with Women with previous caesarean section or other uterine previous caesarean section. surgery, contracted pelvis, Multiple pregnancies, Parity of 4 Prostaglandin E2 gel, intracervical and intravaginal are or more, Placenta Previa, antepartum hemorrhage, recommended but expensive and not a priority for premature rupture of membranes, fetal malpresentation and implementation in low- and middle-income group countries. estimated foetal weight more than 4000 grams or less than Prostaglandins, cyclopentane derivatives of arachidonic acid, 2000 grams were excluded from the study. stimulate remodeling of cervical collagen and act within the uterine myocytes, increasing contractility of uterus. Women with inclusion criteria were randomly divided Misoprostol is expensive, stable at room temperature into two groups of 50 each. The selected women’s baseline and may also be used in the treatment of postpartum demographic data, clinical history was obtained. A clinical haemorrhage, hence, partially useful in poor resource examination was done. Necessary investigations were done. settings. In fact, misoprostol has been recommended to be Modified Bishop’s score was analyzed and fetal used for induction of labour by the World Health cardiotocography was done. In the first group, that is Group Organization and the American College of Obstetricians and A, under aseptic conditions, a sterile vaginal speculum was Gynecologists but, still misoprostol remains unapproved for placed and Foley’s catheter number 16F was inserted induction of labour. through the external os and once when the tip of the Foley’s balloon catheter was associated with lower risk catheter was beyond the internal os in the extra amniotic of uterine hyperstimulation. Hence may be preferred in space, the balloon was filled with 30 cc of normal saline. women with scarred uterus. The mechanism of Foley’s Gentle traction was given, and the catheter was taped to the catheter consists of direct mechanical stretching of cervix thigh. If catheter was expelled within 6 hours after insertion, and lower uterine segment and stimulation of endogenous another Foley’s was inserted under aseptic conditions. In the prostaglandin release following separation of chorionic absence of uterine contractions even after 24 hours, labour membrane and decidua. Use of balloon catheter for cervical induction was done with oxytocin drip. Initially the oxytocin ripening is supported by the WHO, ACOG, SOGC and NICE drip was started at a dose of 1 mu/min and the rate of flow guidelines and there is no increase in maternal or neonatal was enhanced every 20 minutes by 1mu/min in order to infectious morbidity with Foley’s catheter cervical ripening. achieve effective uterine contractions and women went into The advantages of Foley’s catheter are low cost, easy established labour. If at the end of 48 hours, if there was no reversibility, feasibility, less need for continuous fetal improvement in Bishop’s score or there was no onset of monitoring during cervical ripening, safe in a scarred uterus, active phase of labour, it was considered as Failed induction and can be used on outpatient treatment basis. and caesarean section was performed for the patient. The present study aims at comparing the efficacy, safety For the second group of pregnant women, that is, in and
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