PREINDUCTION CERVICAL RIPENING - A COMPARISON OF INTRACERVICAL PROSTAGLANDIN E(2) GEL VERSUS THE FOLEY CATHETER

OBJECTIVE: Both prostaglandin E(2) gel and an intracervical balloon ca theter have been shown to be effective for cervical ripening. The purp ose of this study is to compare the efficacy of intracervical prostagl andin E(2) gel with an intracervical Foley catheter for preinduction c ervical ripening. STUDY DESIGN: A randomized, prospective study was co nducted in the Maternity Care Center at the Foothills Hospital at Calg ary, Alberta, Canada. Patients with a Bishop score less than or equal to 4 and meeting inclusion and exclusion criteria were included. Thirt y patients were randomized to receive prostaglandin E, gel and 36 to r eceive an intracervical Foley catheter on the evening before induction . Induction then proceeded the following morning by the preferred meth od of the attending physician. RESULTS: The groups were comparable wit h respect to maternal age, parity, gestational age, reason for inducti on, and initial Bishop scores. Both groups had a significant change in Bishop score (4.1 +/- 0.4 and 4.8 +/- 0.5, respectively p < 0.001); h owever, there was no significant difference between the groups. There was no significant difference in side effect profile, intrapartum comp lications, or delivery mode. Six cesarean sections (17.6%) were perfor med in the Foley group and seven (25%) in the prostaglandin E, gel gro up (not significant). The induction-to-delivery interval was 16.0 +/- 1.7 hours in the Foley group and 21.5 +/- 3.2 hours in the prostagland in E(2) gel group (p = 0.014). Apgar scores, cord gases, and neonatal birth weight showed no difference between the groups. CONCLUSION: This study has shown that for preinduction cervical ripening there is no d ifference in efficacy between intracervical prostaglandin E(2) gel or an intracervical Foley catheter.