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

Misoprostol or Foley catheter for an unfavorable cervix at term?


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


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.


  • 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.