Practical info on evidence based medicine for your women's healthcare practice

Misoprostol or Foley catheter for an unfavorable cervix at term?

FINDINGS:

Based on a randomized controlled trial (RCT) to determine safety and effectiveness

  • Both misoprostol and Foley catheter will work when considering induction in an unfavorable cervix at term
  • 50 micrograms oral misoprosotol every 4 hours or a 30 ml transcervical Foley catheter did not show a difference in safety profile when looking at fetal asphyxia or postpartum hemorrhage

SYNOPSIS:

In this multicenter, randomized, open label trial, Eikelder and colleagues (Lancet, 2016) studied 932 women with an unfavorable cervix (Bishop score < 6) at term to determine if there is a safety difference between oral misoprostol or Foley catheter.  The primary outcomes considered were a composite score for infant asphyxia (pH less than or equal to 7.05 or 5 minute APGAR less than 7) or postpartum hemorrhage of greater than 1000 ml.

KEY POINTS:

  • Labor induction can occur in up to 30% of pregnancies
  • Oral misoprostol and Foley catheter are both effective to maximize the likelihood of vaginal birth at term
  • Oral misoprostol and Foley catheter are similar in safety and effectiveness

Learn More:

Induction of labour at term with oral misoprostol versus a Foley catheter (PROBAAT-II): a multicentre randomised controlled non-inferiority trial.