title: Combining medical and mechanical methods of cervical ripening. Does it increase the likelihood of successful induction of labor?
abstract: OBJECTIVE
  To determine if combining two commonly used methods or cervical ripening (intracervical prostaglandin E2 [Pge2] gel and Foley balloon catheter) would result in a higher number of successful inductions and fewer cesarean sections when compared to PGE2 gel alone.
  
  
  METHODS
  Seventy-eight patients with unfavorable cervixes eligible for induction of labor were prospectively randomized to receive either one dose (0.5 mg) of PGE2 gel followed by insertion of a 24-French Foley catheter (group 1, 41 patients) or two doses of 0.5 mg of intracervical gel (group 2, 37 patients). Outcome parameters included change in Bishop score, number of failed inductions, rate of cesarean section, rate of uterine hyperstimulation and postpartum infection.
  
  
  RESULTS
  Patients in group 1 had a significant increase in posttreatment Bishop scores (7.26 +/- 2.0 SD vs. 4.82 +/- 1.8 P = .0001) and fewer failed inductions (0 vs. 6, P = .009) when compared to patients in group 2. Abdominal delivery rates, uterine hyperstimulation and infections complications were not different between the two groups.
  
  
  CONCLUSIONS
  The combination of the Foley balloon and prostaglandin gel significantly improved the Bishop score and led to fewer failed inductions, although it did not increase the vaginal delivery rate.
authors.affiliation: Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Sullivan
authors.forename: L W
authors.initials: LW
authors.lastname: Benton
authors.forename: H
authors.initials: H
authors.lastname: Roach
authors.forename: L G
authors.initials: LG
authors.lastname: Smith
authors.forename: R W
authors.initials: RW
authors.lastname: Martin
authors.forename: J C
authors.initials: JC
authors.lastname: Morrison
mesh_terms: D000328:Adult; D002404:Catheterization; D002584:Cervix Uteri / Q000503:physiopathology*; D002585:Cesarean Section; D015232:Dinoprostone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005782:Gels; D006801:Humans; D007751:Labor, Induced; D011247:Pregnancy; D011446:Prospective Studies; D002577:Uterine Cervical Diseases / Q000503:physiopathology / Q000628:therapy*
chemical_list: D005782:Gels; D015232:Dinoprostone