COMPARATIVE STUDY OF EFFICACY OF INTRACERVICAL FOLEY’S WITH INTRACERVICAL PGE2 GEL VS. PGE2 GEL ALONE FOR INDUCTION OF LABOUR AT TERM GESTATION
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Keywords
induction of labour, cervical ripening, intracervical Foley’s catheter, PGE2 gel, term pregnancy, Bishop score, Apgar score, obstetric outcomes
Abstract
Background: Induction of labour is indicated when continuing pregnancy poses risk to the mother or fetus, and success depends largely on cervical ripening. Both mechanical (Foley’s catheter) and pharmacological (PGE2) methods are used, but evidence on their combined use at term remains limited.
Objectives: To compare intracervical Foley’s catheter with PGE2 gel versus PGE2 gel alone for induction of labour at term in terms of: induction–delivery interval, need for oxytocin augmentation, mode of delivery, and fetal outcome including Apgar scores.
Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, subbaiah institute of medical sciences and research centre, Shivamogga over one year, including 100 women with singleton, cephalic, term pregnancies (gestation >36 weeks) and unfavorable cervix who required induction. Eligible women were randomized into Group A (n=50, simultaneous transcervical Foley’s catheter plus intracervical 0.5 mg PGE2 gel) and Group B (n=50, PGE2 gel alone, repeatable 6‑hourly up to 3 doses), and followed for Bishop score change, induction–delivery interval, oxytocin use, mode of delivery, and neonatal Apgar scores.
Results: Most women in both groups were 21–30 years and primigravida, with comparable baseline characteristics and pre‑induction Bishop scores (~3.4). After induction, Bishop scores of 6–10 occurred in 94% of Group A versus 82% of Group B (P<0.045), and mean Apgar scores were significantly higher in Group A at 1 minute (7.94±0.24 vs 7.76±0.43, P=0.011) and 5 minutes (9.00±0.00 vs 8.80±0.40, P=0.001).
Conclusion: Combined use of intracervical Foley’s catheter with PGE2 gel yields significantly better cervical ripening and neonatal Apgar scores than PGE2 gel alone for term induction of labour. This combination appears more effective and safer, offering favourable maternal and fetal outcomes in women requiring induction at term.
References
2. World Health Organization. Department of reproductive health and research. WHO recommendations for induction of labour. Geneva. Switzerland: World Health Organisation; 2011:32
3. Garg R, Vardhan S, Singh S, Singh R. Foley catheter with vaginal prostaglandin E2 gel versus vaginal prostaglandin E2 gel alone for induction of labour: a randomized controlled trial. Int J Reprod Contracept Obstet Gynecol. 2018;7:1893.
4. Carbone JF, Tuuli MG, Fogertey PJ, Roehl KA, Macones GA. Combination of Foley bulb and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and labor induction: a randomized controlled trial. Obstetrics & Gynecology. 2013 Feb 1;121(2 PART 1):247-52.
5. Kaur K, Kaur B, Kaur N, Kaur G. Intra-cervical foley's catheter or PGE2 gel for induction of labour: which one is better: a prospective study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2021 May 1;10(5):1802-9.
6. Pennell C, Henderson J, O’Neill M, McCleery S, Doherty D, Dickinson J. Induction of labour in nulliparous womenwith an unfavourable cervix: a randomised controlled trial comparing double and single balloon catheters and PGE2 gel. BJOG 2009;116:1443–1452.
7. Mathuriya G, Kushwaha SP, Pradhan S. Comparative study of induction of labour with dinoprostone gel versus mechanical dilatation in unfavorable cervix (low Bishops Score). International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017 Oct 1;6(10):4363-7.
8. Shankarappa VK, Natarajan P, Natarajan M. Comparison of PGE2 gel alone versus sequential use of Foley's catheter and PGE2 gel in the ripening of unfavorable cervix: a retrospective study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2021 Jan 1;10(1):127-32.
9. Atad J, Bornstein J, Calderon I, Petrikovsky BM, Sorokin Y, Abramovici H. Nonpharmaceutical ripening of the unfavorable cervix and induction of labor by a novel double balloon device. Obstet Gynecol. 1991 Jan;77(1):146-52.
10. Prager M, Eneroth-Grimfors E, Edlund M, Marions L. A randomised controlled trial of intravaginal dinoprostone, intravaginal misoprostol and transcervical balloon catheter for labour induction. BJOG 2008;115:1443–1450.
11. Du C, Liu Y, Liu Y, Ding H, Zhang R, Tan J. Double-balloon catheter vs. dinoprostone vaginal insert for induction of labor with an unfavorable cervix . June 2015, 291(6):1221-1227.
12. Deshmukh VL, Yelikar KA, Deshmukh AB. Comparative Study of Intra-cervical Foley’s Catheter and PGE 2 Gel for Pre-induction Ripening (Cervical). The Journal of Obstetrics and Gynecology of India. 2011 Aug 1;61(4):418.
13. Revathi V, Archana I. A comparative study of efficacy of intracervical prostaglandin E2 gel and intracervical foleys catheter for preinduction cervical ripening. IOSR J of dental and med sci. 2015;14(4):42-6.
14. Alam A, Ahmed EA. A comparative study of intracervical foley’s catheter and PGE2 gel for preinduction cervical ripening. Int J Reprod Contracept Obstet Gynecol. 2016; 5:2644-7.
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Dr Soumya B G
Assistant professor, Department of obstetrics and Gynaecology, Subbaiah Institute of Medical Sciences and Research Centre, Shivamogga, Karnataka.
Dr Chetana Rao N
Assistant professor, Department of obstetrics and Gynaecology, Subbaiah Institute of Medical Sciences and Research Centre, Shivamogga, Karnataka.
Dr Shashikumar N S
Associate professor, Department of obstetrics and Gynaecology, Subbaiah Institute of Medical Sciences and Research Centre, Shivamogga, Karnataka.
