Intracervical foley catheter plus intravaginal misoprostol vs intravaginal misoprostol alone for cervical ripening: A meta-analysis

Howard Hao Lee, Ben Shian Huang, Min Cheng, Chang Ching Yeh, I. Chia Lin, Huann Cheng Horng, Hsin Yi Huang, Wen Ling Lee, Peng Hui Wang

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)

Abstract

Currently, there is no meta-analysis comparing intravaginal misoprostol plus intracervical Foley catheter versus intravaginal misoprostol alone for term pregnancy without identifying risk factors. Therefore, the purpose of this study is to conduct a systematic review and meta-analysis of randomized control trials (RCTs) comparing concurrent intravaginal misoprostol and intracervical Foley catheter versus intravaginal misoprostol alone for cervical ripening. We systematically searched Embase, Pubmed, and Cochrane Collaboration databases for randomized controlled trials (RCTs) comparing intracervical Foley catheter plus intravaginal misoprostol and intravaginal misoprostol alone using the search terms “Foley”, “misoprostol”, “cervical ripening”, and “induction” up to 29 January 2019. Data were extracted and analyzed by two independent reviewers including study characteristics, induction time, cesarean section (C/S), clinical suspicion of chorioamnionitis, uterine tachysystole, meconium stain, and neonatal intensive care unit (NICU) admissions. Data was pooled using random effects modeling and calculated with risk ratio (RR) and 95% confidence interval (CI). Pooled analysis from eight studies, including 1110 women, showed that labor induction using a combination of intracervical Foley catheter and intravaginal misoprostol decreased induction time by 2.71 hours (95% CI −4.33 to −1.08, p = 0.001), as well as the risk of uterine tachysystole and meconium staining (RR 0.54, 95% CI 0.30–0.99 and RR 0.48, 95% CI 0.32–0.73, respectively) significantly compared to those using intravaginal misoprostol alone. However, there was no difference in C/S rate (RR 0.93, 95% CI 0.78–1.11) or clinical suspicion of chorioamnionitis rate (RR 1.22, CI 0.58–2.57) between the two groups. Labor induction with a combination of intracervical Foley catheter and intravaginal misoprostol may be a better choice based on advantages in shortening induction time and reducing the risk of uterine tachysystole and meconium staining compared to intravaginal misoprostol alone.

Original languageEnglish
Article number1825
JournalInternational journal of environmental research and public health
Volume17
Issue number6
DOIs
Publication statusPublished - Mar 2020
Externally publishedYes

Keywords

  • Induction
  • Intracervical Foley catheter
  • Intravaginal misoprostol
  • Labor
  • Term pregnancy

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

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