REFERAT

Intravaginal misoprostolversus
Foley catheter for labour
induction: a meta-analysis

Fox, N.S., Saltzman, D.H., Roman, A.S., Klauser, C.K., Moshier, E.,
Rebarber, A., 2011. Misoprostol versus Foley catheter for labour
induction: a meta-analysis. British Journal of Obstetrics and
Gynecology: 647-654.
 Background

In the recent decade, there has been a considerable

increase in the rate of labor induction, a common
method in the termination of pregnancy. Approximately,
20% of all deliveries are initiated with this method. Labor
induction is usually performed when the risks of
continuing a pregnancy are more than the benefits of
delivery. Undoubtedly, cervical ripening has a close
relationship with the success rate of delivery.
For the patient with an unfavourable cervix, a number of
cervical ripening agents are available. These include
mechanical dilation and prostaglandin administration.

Vahid Roudsari F et al. / IJPR (2011), 10 (1): 149-154

Fox, N.S., Saltzman, D.H., Roman, A.S., Klauser, C.K., Moshier, E., Rebarber, A., 2011. Misoprostol versus
Foley catheter for labour induction: a meta-analysis. British Journal of Obstetrics and Gynecology:
647-654.
 Induction of Labour

DEFINITIONS
Induction of labour is the initiation of contractions in
a pregnant woman who is not in labour to help her
achieve a vaginal birth within 24 to 48 hours.
For the patient with an unfavourable cervix, a
number of cervical ripening agents are available.
These include mechanical dilation and
prostaglandin administration.

Leduc, et al. 2013. Induction of Labour. Journal of Obstetric and Gynecology Canada
(2013);35(9):840857
Fox, N.S., Saltzman, D.H., Roman, A.S., Klauser, C.K., Moshier, E., Rebarber, A., 2011. Misoprostol versus
Foley catheter for labour induction: a meta-analysis. British Journal of Obstetrics and Gynecology:
647-654.
Misoprostol
Misoprostol, a synthetic prostaglandin E1 analogue,
it was developed for the prevention and treatment
of peptic ulcers because of its gastric acid anti-
secretory properties and its various mucosal
protective properties.
Misoprostol is also commonly used for medical
abortion, cervical priming, the management of
miscarriage, induction of labor and management
of postpartum hemorrhage.
Tang, O.S., Gemzell-Danielsson, K., Ho, P.C. 2007. Misoprostol:
Pharmacokinetic profiles, effects on the uterus and side-effect.
International Journal of Gynecology and Obstetrics (2007) 99, S160-
 Pharmacokinetic properties of the
various routes of administrationof
misoprostol

Tang, O.S., Gemzell-Danielsson, K., Ho, P.C. 2007. Misoprostol: Pharmacokinetic profiles, effects
on the uterus and side-effect. International Journal of Gynecology and Obstetrics (2007) 99,
Dosages of
Misoprostol
 Effects of the uterus and the
cervix
Uterus
After a single dose of vaginal misoprostol
administration there is an increase in uterine
tonus. That similar to that misoprostol of oral
administration.
Cervix
The softening effect is more likely to be due to the
direct effect of misoprostol on the cervix.

Tang, O.S., Gemzell-Danielsson, K., Ho, P.C. 2007. Misoprostol: Pharmacokinetic profiles, effects
on the uterus and side-effect. International Journal of Gynecology and Obstetrics (2007) 99,
S160-S167.
Side effect and incidence of
fetal malforations
Chills were reported in 32-57 % of women
receiving misoprostol
Hyperpyrexia has been reported in several
cases following 600 microgram
The risk of uterine rupture, especially in women
with previous uterine scar.
The incidence of infection has been reported
to be only 0.92%
In early pregnancy has been associated with
multiple congenital defect.
Foley Catheter
Ripening of the unfavorable cervix in
primiparous women with a Foley catheter
balloon inflated with 80 mL provided effective
more dilatation, faster labor, and decreased
need for oxytocin than with a balloon inflated
with 30 mL of sterile saline.
Discussion
The purpose of this study was to review the
evidence from randomised trials comparing the
effectiveness of vaginal misoprostol and
transcervical Foley catheter for the purpose of
cervical ripening and induction of labour.
A literature search was conducted in Embase
(January 1980November 2010) and PubMed (US
National Library of Medicine, January 1966
November 2010) to identify prospective,
randomised trials with published data in English
comparing the use of intravaginal misoprostol and
transcervical Foley catheter for the purpose of
cervical ripening and induction of labour.
The primary
outcomes selected
were :
time to delivery
the rates of
cesarean section
uterine
tachysystole
chorioamnionitis
Result
Time to delivery
Using the random-effects estimate, there was
no significant difference in the mean time to
delivery between women who received
misoprostol compared with transcervical Foley
catheter (mean difference 1.08 2.19 hours
shorter for misoprostol, P = 0.2348). The
heterogeneity between studies was significant,
with P < 0.0001. The estimate of I2 was 84%.
Result
Rate of caesarean delivery
Using the random-effects estimate, there was
no significant difference in the rate of
caesarean delivery between women who
received misoprostol compared with
transcervical Foley catheter (RR 0.991; 95% CI
0.7683, 1.278). The heterogeneity between
studies was not significant, with P = 0.4840. The
estimate of I2 was 0%.
Result
Rate of chorioamnionitis
Using the fixed-effects estimate, there was no
significant difference in the rate of
chorioamnionitis between women who
received misoprostol compared with
transcervical Foley catheter (RR 1.130, 95% CI
0.611, 2.089). The heterogeneity between
studies was not significant, with P = 0.3900. The
estimate of I2 was 0%.
Result
Rate of tachysystole
Using the random-effects estimate, patients
who received misoprostol had significantly
higher rates of tachysystole compared with
women who received a transcervical Foley
catheter (RR 2.844; 95% CI 1.392, 5.812). The
heterogeneity between studies was not
significant, with P = 0.5230. The estimate of I2
was 0%.
Result
In this meta-analysis of prospective, randomised
studies with 1603 patients undergoing induction
of labour, the administration of vaginal
misoprostol and the use of a transcervical Foley
catheter had similar effectiveness in achieving
vaginal delivery, and in a similar time frame.
There was also no difference in the rate of
chorioamnionitis, although there were only two
studies that reported this outcome. However,
there was a 2.8-fold increase in the rate of
uterine tachysystole with the use of misoprostol,
compared with the use of a transcervical Foley
catheter.
Conclusion
Misoprostol and transcervical Foley catheter
are both considered appropriate induction
agents by ACOG.
The administration of vaginal misoprostol and
the use of a transcervical Foley catheter had
similar effectiveness in achieving vaginal
delivery.
Transcervical Foley catheter is associated with
a lower incidence of tachysystole.
Thank you!!! :)