Iranian Society of Gynecology Oncology

Document Type : Original Research Article


Department of Gynecology and Obstetrics, Al-Nahrain College of Medicine, Al-Nahrain University, Jadriya,Baghdad, Iraq


Introduction: Inducing labor is a common practice in obstetrics to prevent maternal and fetal complications. There are several methods of labor induction, including pharmacological and mechanical approaches. The objective of this study was to determine the most effective approach for labor induction.
Method: A cross-sectional study at Al-Kadhimiya Teaching Hospital compared labor induction in pregnant females at their third trimester using Misoprostol & Foley Catheter (group A) and Misoprostol alone (group B). The study collected data on maternal age, gestational age, BMI, time frames, mode of delivery, and neonatal outcomes such as Apgar scores and ICU admissions.
Results: In a cross-sectional study comparing labor induction with Misoprostol & Foley Catheter (group A) vs. Misoprostol alone (group B), most females in both groups had no cesarean section inductions, normal vaginal deliveries, and no complications. The study found significant differences in BMI, time frame, and time for ripening between the two groups, with group A having lower values for these variables.
Conclusion: Foley's with vaginal misoprostol results in a shortened time between induction and delivery than misoprostol alone.


Main Subjects

1. Alfirevic Z, Kelly AJ, Dowswell T. Intracervical Foley catheter versus intravaginal misoprostol for induction of labour at term (Review). Cochrane Database Syst Rev. 2009.
2. Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2010(10):CD000941. [DOI:10.1002/14651858.CD000941.pub2]
3. Kaur G, Sharma D. Comparison of Vaginal Misoprostol Alone versus a Combination of Vaginal Misoprostol and Intracervical Foley Catheter for Induction of Labor: A Randomized Controlled Trial. J Clin Diagnostic Res. 2016;10(2):QC04-QC7.
4. Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Medley N, Dias S, et al. Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess. 2016;20(65):1-583. [DOI:10.3310/hta20650] [PMID] [PMCID]
5. Chen W, Xue J, Peprah MK, Wen SW, Walker M, Gao Y, Tang Y. A systematic review and network meta-analysis comparing the use of Foley catheters, misoprostol, and dinoprostone for cervical ripening in the induction of labour. BJOG. 2016;123(3):346-54. [DOI:10.1111/1471-0528.13456] [PMID]
6. Dahiya K, Ahuja K, Dhingra A, Duhan N, Nanda S. Efficacy and safety of mifepristone and buccal misoprostol versus buccal misoprostol alone for medical abortion. Arch Gynecol Obstet. 2012;285:1055-8. [DOI:10.1007/s00404-011-2110-8] [PMID]
7. Penfield CA, Wing DA. Labor induction techniques: which is the best?. Obstet Gynecol Clin. 2017 Dec 1;44(4):567-82. [DOI:10.1016/j.ogc.2017.08.011] [PMID]
8. Alfirevic Z, Aflaifel N, Weeks A. Oral misoprostol for induction of labour. Cochrane Database Syst Rev. 2014;2014(6):CD001338. [DOI:10.1002/14651858.CD001338.pub3] [PMID] [PMCID]
9. Naseer J. Mifepristone for induction of labour. Cochrane Database Syst Rev. 2016.
10. Jozwiak M, Oude Rengerink K, Ten Eikelder MLG, van Pampus MG, Dijksterhuis MGK, de Graaf IM, et al. Foley catheter or prostaglandin E2 inserts for induction of labour at term: an open-label randomized controlled trial (PROBAAT-P trial) and systematic review of literature. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):137-45. [DOI:10.1016/j.ejogrb.2013.06.017] [PMID]
11. Alfirevic Z, Keeney E, Dowswell T, Welton NJ, Dias S. Methods for induction of labour: a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2017. [DOI:10.1097/01.aoa.0000521242.56502.14]
12. Gülmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane database of systematic reviews. 2012(6):CD004945. [DOI:10.1002/14651858.CD004945.pub3]
13. Boulvain M, Kelly A, Irion O, Dowswell T. Mechanical and pharmacological methods for induction of labour for cervical ripening or induction of labour in non multiparous women. Cochrane Database Syst Rev. 2018.
14. Gizzo S, Saccardi C, Patrelli TS, Di Gangi S, Carpano M, Nardelli GB. Comparison of intravaginal misoprostol versus intravenous oxytocin for labor induction in term pregnancy with unfavorable cervix: randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2016;203:204-9.
15. Moghadam BK, Ghalandar-Attar MS, Karimi-Sari H, Mokhtari M. Comparison of the effectiveness and safety of Foley catheter and misoprostol in induction of labor. Iran J Nurs. 2015;28(92):24-32.
16. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol. 2013;121(1):213-7. [DOI:10.1097/01.AOG.0000425667.10377.60] [PMID]
17. Vahratian A. Outcomes of induction of labor in relation to maternal body mass index. J Womens Health. 2005;14(9):824-8.
18. Da W. A comparison of orally administered misoprostol with vaginally administered misoprostol for cervical ripening and labor induction. Am J Obstet Gynecol. 1999;180:1155-60. [DOI:10.1016/S0002-9378(99)70610-1] [PMID]
19. Alfirevic Z, Kelly AJ. Techniques for induction of labour: a systematic review. BJOG: An International. J Obstet Gynaecol. 2009;116(4): 527-38.
20. Li Y, He Y, Liu M, Li Y, Zhang Y. Comparison of misoprostol plus Foley catheter with misoprostol alone for induction of labor in obese women. J Obstet Gynaecol Canada. 2019;41(12):1747-52.
21. Torky HA, Abbas AM. Foley catheter versus vaginal misoprostol followed by oxytocin for induction of labor: a randomized controlled trial. J Matern Fetal Neonatal Med. 2019;32(22):3799-806.
22. Ahmadi S, Farahani K, Aklamli M, Ahmadi K, Beheshti N. Spinal Analgesia in Labor on Maternal and Neonatal Outcomes: A Retrospective Cross Sectional Study. J Obstet Gynecol Cancer Res. 2022;7(3):186-91. [DOI:10.30699/jogcr.7.3.186]
23. Keikha F, Shooshtari M, Zamani N. Uterine Rupture in Second Trimester Due to Misoprostol Use: A Case Report and Literature Review. J Obstet Gynecol Cancer Res. 2022;7(3):243-6. [DOI:10.30699/jogcr.7.3.243]