Effectiveness and Safety of Low Dose Vaginal Misoprostol Compared to Trans Cervical Foley Catheter for Cervical Ripening and Induction of Labor in Post Term Pregnant Women Admitted to Gandi Memorial Hospital, Addis Ababa and Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia

Background: Post term pregnancy is one of the common indications of induction of labor in contemporary obstetric practice. However, the majority of women with post term pregnancy have unfavorable cervices. Therefore, it is mandatory to achieve cervical ripening in this group of women before proceeding to labor induction. These cervical ripening methods often result in onset of labor which makes them also labor inducing agents. There is paucity of studies comparing the effectiveness and safety of the aforementioned methods. Thus, this study compared the effectiveness and safety of low dose vaginal misoprostol with trans cervical Foley catheter for cervical ripening and induction of labor in post term pregnant women. Method: The study was conducted from January to December 2014 at Gandi Memorial Hospital and Felege Hiwot Referral Hospital. Quasi-experimental study design was employed and 111 post term pregnant women were enrolled to each group of cervical ripening methods. Foley catheter, number 18 gauge, was inserted trans cervically and inflated with 50 ml of normal saline in women of group I at FHRH. Women in group II received 25 μg of misoprostol vaginally every 6 hrs for a maximum of 2 doses at GMH. Oxytocin infusion began when an indication comes to picture. Results were tabulated and statistically analyzed. Results: Baseline obstetric variables such as gestational age and parity were not statistically different in both groups. Maternal age was found to be statistically significant (28.40 vs. 26.02 yrs; P=0.000). Change in Bishop score is marginally significant in favour of the Foley catheter group even after controlling for maternal age (5.67 vs. 5.33; P=0.040). Vaginal delivery within 24 hours and ripening to delivery intervals were not statistically different in both groups. Rate of vaginal delivery was found to be marginally significant being higher in the Foley catheter group (84.7% vs. 72.2%; P=0.013). When stratified for parity, the significance was in multiparous women (93.4% vs. 78.3%; P=0.012). Need for oxytocin was significantly higher in the Foley catheter group (75.7% vs. 43.2%; P<0.0001). Indications for caesarean section were NRFHRP and failed induction, no statistical difference was seen in both groups. Uterine tachysystole with FHR abnormality (0 vs. 12.6%; P<0.001) and abnormal FHR is significantly higher in the Misoprostol group (6.3% vs. 26.1%; P<0.0001). More importantly 3 cases of uterine rupture with 2 intrapartal fetal loss were encountered in the misoprostol group and all were multiparous women. Both groups were not statistically different for rates of meconium stained amniotic fluid, neonatal birthweight, low APGAR scores and NICU admissions. Furthermore 3 cases and 1 case of ENND occurred in the Misoprostol and Foley catheter group respectively. There were no cases of chorioamnionitis, endomyometritis, uterine atony and maternal death in both groups. Recommendation: Foley catheter is relatively better in ripening the cervix with more need for oxytocin compared to misoprostol in post term pregnancy. Safety issues need to be taken into account while deciding to use misoprostol as a cervical ripening agent especially for multiparous post term pregnant women. Foley catheter with 50 ml volume inflation is used for multiparous post term pregnant women. Either method can be used in nulliparous ones based on individual clinical judgement. Randomized controlled trial with larger sample size needs to be conducted in the future.