Combined Foley's catheter with vaginal misoprostol for pre-induction cervical ripening: A randomised controlled trial

Background: Pre-induction cervical ripening greatly influences the outcome of induction of labour (IOL). Aims: To compare the efficacy of combined Foley's catheter and vaginal misoprostol with Foley's catheter or low-dose vaginal misoprostol alone for cervical ripening. Materials and methods: Women with a singleton pregnancy admitted at term for cervical ripening and IOL based on clinical indication were randomised into three groups. Oxytocin augmentation was done in the groups as indicated. Significant tests were done using chi square, Fisher's exact and analysis of variance tests. Results: A total of 210 women were randomised into the study. Women in the combined group (Foley's catheter and vaginal misoprostol) had significantly higher postcervical ripening Bishop's score than the women in the other two groups; P = 0.001. Cervical ripening time, induction–delivery time and cervical ripening–delivery interval were significantly shorter in the combined group compared to the other two groups; P = 0.001. Also, women in the combined group required significantly lesser oxytocin augmentation than the other two groups; P = 0.001. There was no difference in Apgar scores at 1 or 5 minutes or in special baby care unit admission among the groups. There were no reported cases of uterine contractile abnormalities or rupture in this study. Conclusion: Combined Foley's catheter and vaginal misoprostol provide a shorter duration to the achievement of cervical ripening.