Extra-amniotic Foley catheter and prostaglandin E-2 gel for cervical ripening at term gestation

Objective: This study evaluated the efficacy of intravaginal prostaglandin E-2 gel in comparison with that of a Foley catheter for cervical ripening a nd induction of labor. Study Design: Consecutive patients with unfavorable cervix requiring preinduction cervical ripening and induction of labor at t erm gestation were asked to participate in the study. One hundred and two p atients were assigned to treatment with intravaginal prostaglandin E-2 gel (group 1) and 122 patients underwent the placement of an intracervical Fole y catheter (group 2). After a maximum of three applications of intravaginal prostaglandin E-2 gel (18 h) or after 18 h from Foley catheter insertion o xytocin was administered to patients not in active labor. Labor profiles an d pregnancy and neonatal outcome were compared between groups. Results: The groups were comparable in term of demographic characteristics, indications for induction of labor, Bishop score at admission. The induction to labor time and the induction to delivery time were similar between groups. The ce sarean sections rate was higher in group 1 than in group 2 (26.5 versus 14. 7%, P < 0.05). This remained significant when the analysis was restricted t o nulliparous patients (32.3 versus 14.2%). The incidence of urinary tract infections, chorioamnionitis, and febrile morbidity was similar between gro ups. Conclusion: For preinduction cervical ripening, the Foley catheter is a valid alternative to the application of intravaginal prostaglandin E-2 ge l and it is associated with a lower cesarean rate in nulliparous women. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.