Oral Misoprostol for 48 hours Versus a Supra Cervical Foley Catheter for 48 Hours for Induction of Labour in Post Dated Pregnancies: A Randomized Control Trial

Abstract

Aims: To assess the feasibility of administration of three doses of oral misoprostol (OM) 50 µg four hourly per day for 48 hours versus the insertion of a supra cervical Foley catheter for 48 hours, in women at 40 weeks + 5 days gestation, and compare the effectiveness of the two methods for induction of labour (IOL).

Method: An investigator blinded, randomized controlled trial was conducted at the academic obstetric unit, Teaching Hospital Mahamodara, Galle from 13.10.2016 to 30.04.2017. Consecutive women (n=144) with singleton uncomplicated pregnancies having Modified Bishop Score (MBS) <5 at 40weeks + 5days gestation were allocated by stratified (primigravidae/ multigravidae) block randomization to receive three doses of OM 50µg four hourly per day for 48 hours or a supra cervical Foley catheter for 48 hours.

Results: Compared to the Foley, OM resulted in higher rates of successful IOL (67% vs 47%, RR 1.4, 95% CI 1.1 - 2.0, p =0.029), more vaginal deliveries within 24 hours and 48 hours, shorter mean induction delivery intervals and greater mean increase in MBS in those not in labour after 48 hours. There was non-significant increased frequency of excessive uterine activity, cardiotocograph abnormalities and meconium stained liquor after OM but no differences in the rates of caesarean deliveries and maternal or neonatal morbidity or mortality between the two groups.

Conclusion: The administration of three doses oral misoprostol (OM) 50 µg four hourly per day for 48 hours as well as the insertion of a supra cervical Foley catheter for 48 hours were feasible for women at 40 weeks + 5 days gestation, but OM was more effective than the Foley catheter for IOL.