A prospective, randomized comparison of Foley catheter insertion versus intracervical prostaglandin E-2 gel for preinduction cervical ripening

OBJECTIVE: The objective of this study was to compare intracervical prostag landin E-2 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 less than or equal to 5 were randomly assigned to treatment wi th either prostaglandin E-2 gel or a Foley bulb. Prostaglandin E-2 gel was used according to the manufacturer's recommendation. The Foley group had a number 14 Foley catheter inserted, inflated, and placed on traction. immedi ately after Foley bulb extrusion or 6 hours after prostaglandin E-2 gel cou rse completion, a dilute oxytocin solution was started if the patient was n ot in labor. RESULTS: Seventy-seven women were entered into the Foley group and 72 were entered into the prostaglandin E-2 gel group. Both the Bishop score after p reinduction 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 u se, oxytocin use, or nonreassuring fetal heart rate patterns. The preinduct ion time (9.9 vs 17.2 hours, P < .001) and the total induction time (22.4 v s 30.4 hours, P < .001) were significantly shorter in the Foley group. Pati ent charges were 31% lower in the Foley group (P < .001). CONCLUSION: Use of the Foley catheter resulted in a higher postinduction Bi shop score, a greater change in Bishop score, a shorter induction time, and lower patient charges than did intracervical prostaglandin E-2 gel.