Comparison of the Efficacy of PGE2 Suppository and Cervical Foley Catheter with Pre-induction Ripening of the Cervix

Background: An increasing success in induction of labor and subsequent termination of pregnancy in presence of unfavorable cervix requires cervical ripening in order to reduce complications and to diminish the rate of cesarean sections as well as the duration of labor.  However, there is no consensus on the efficiency of conventional methods for cervical ripening. Objective: To determine and compare the effects of PGE2 suppositories and inflated Foley catheter on pre-induction ripening of the cervix. Methods:In a quasi-experimental study, 70 pregnant women with a gestational age between 14 and 28 weeks and unfavorable cervix, requiring induction of labor were randomly allocated into to 2 groups.  For each mother, digital cervical examination was performed before and at regular intervals to determine the Bishop score.  One group received vaginal suppository of 3 mg dino-prostone that was re-administered after 6 hours, if necessary.  For the other group, a Foley catheter balloon was inserted in the internal os of cervix that was filled with 30 mL sterile normal saline and kept under traction.  Serum oxytocin augmentation was given to both groups after 12 hours as a routine.  The outcome variables including the change in cervical Bishop score, beginning of uterine contractions and complications during and after labor were assessed.  Student’s t test and Chi-square were used for the analyses of data. Result: Induction to delivery time in Foley catheter group (15.0±7.7 h) was significantly (p<0.01) lower than that of PGE2 group (20.8±5.8 h).  The rate of post-partum curettage for residual placenta or post-partum infections which required hospitalization and other complications were similar in both groups.  The time saved for cervical ripening in Foley catheter group was 6.4±4.2 h.