Preinduction cervical ripening techniques compared

OBJECTIVE: To assess the clinical efficacy of pharmacologic, mechanical and combination techniques of cervical ripening. STUDY DESIGN: From March 1997 to August 1998, all cervical-ripening patient s at Lehigh Valley Hospital were randomly assigned to three groups: intrava ginal, misoprostol, intracervical Foley catheter, or combination prostaglan din E-2 (PGE(2)) gel and Foley catheter. Inclusion criteria included Bishop score less than or equal to5 and no contraindication to labor. The remaini ng delivery process was actively managed according to established guideline s. Multiple variables in perinatal outcome were analyzed, with the cesarean section rte and time from ripening to delivery as the main outcome variabl es. RESULTS:Of the 205 patients, 65 were randomized to the misoprostol group, 7 1 to the Foley group nad 69 to the catheter-and-gel group. There were no di fferences between groups in delivery indications, maternal demographics, ul trasound findings, labor interventions, intra-partum times, mode of deliver y, postpartum complications or neonatal outcomes. The misoprostol group dem onstrated a higher rate of uterine tachysystole with misoprostol did not in crease the cesarean section rate. CONCLUSION: The higher rate if oxytocin required by the two catheter groups did not increase the delivery time intervals. There appears to be no benef it to adding intracervical or intravaginal PGE(2) gel to the intracervical Foley balloon. The misoprostol and catheter ripening techniques have simila r safety and efficacy.