A prospective, randomized comparison of Foley catheter insertion versus intracervical prostaglandin E2 gel for preinduction cervical ripening

Abstract

Objective: The objective of this study was to compare intracervical prostaglandin E2 gel with insertion of a Foley bulb for efficacy in preinduction cervical ripening.

Study design: Women who came to the hospital for induction of labor with a Bishop score </=5 were randomly assigned to treatment with either prostaglandin E2 gel or a Foley bulb. Prostaglandin E2 gel was used according to the manufacturer's recommendation. The Foley group had a number 14 Foley catheter inserted, inflated, and placed on traction. Immediately after Foley bulb extrusion or 6 hours after prostaglandin E2 gel course completion, a dilute oxytocin solution was started if the patient was not in labor.

Results: Seventy-seven women were entered into the Foley group and 72 were entered into the prostaglandin E2 gel group. Both the Bishop score after preinduction ripening (6.5 vs 5.1, P <.001) and the change in Bishop score (3.5 vs 2.7, P =.015) were significantly higher in the Foley group. There were no differences between the groups in mode of delivery, infant weight, rate of hyperstimulation, shoulder dystocia, patient discomfort, epidural use, oxytocin use, or nonreassuring fetal heart rate patterns. The preinduction time (9.9 vs 17.2 hours, P <.001) and the total induction time (22.4 vs 30.4 hours, P <.001) were significantly shorter in the Foley group. Patient charges were 31% lower in the Foley group (P <.001).

Conclusion: Use of the Foley catheter resulted in a higher postinduction Bishop score, a greater change in Bishop score, a shorter induction time, and lower patient charges than did intracervical prostaglandin E2 gel.