title: Preinduction cervical ripening. A randomized trial of intravaginal misoprostol alone vs. a combination of transcervical Foley balloon and intravaginal misoprostol.
abstract: OBJECTIVE
  To determine if the addition of a mechanical ripening agent (transcervical Foley balloon) to a pharmacologic agent (intravaginal misoprostol) improves the efficiency of preinduction cervical ripening.
  
  
  METHODS
  Singleton patients with an indication for delivery, unfavorable cervix (Bishop score < or = 5) and no contraindication to labor were randomly assigned to two groups: misoprostol alone (25 micrograms intravaginally every 3 hours for no more than 12 hr) or combination therapy (25-French transcervical Foley balloon inflated to 50 mL of sterile water with identical intravaginal misoprostol dosing). All patients received a history and physical examination (including Bishop score), preripening ultrasound, electronic fetal heart rate and contraction monitoring (to rule out spontaneous labor and document fetal well-being). Multiple variables of perinatal outcome were analyzed, including the main outcome variables of ripening-to-delivery time and cesarean section rate.
  
  
  RESULTS
  During August 1998 to August 1999, 81 patients were randomized, 40 to misoprostol alone and 41 to combination therapy. There were no differences between the groups with respect to maternal demographics, preripening Bishop score, maternal complications, intrapartum intervention or neonatal outcome. The misoprostol group spent longer periods of time in active labor, and there was a trend for the combination group to require oxytocin for longer intervals. These findings did not significantly affect the total ripening-to-delivery time or cesarean section rate which were similar for both groups.
  
  
  CONCLUSIONS
  The addition of mechanical ripening with a transcervical Foley balloon to intravaginal misoprostol did not improve the efficiency of preinduction cervical ripening. Mechanical and pharmacologic cervical ripening agents appear to act independently rather than synergistically.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Hospital, Allentown, Pennsylvania 18105-1556, USA.
authors.forename: O A
authors.initials: OA
authors.lastname: Rust
authors.forename: M
authors.initials: M
authors.lastname: Greybush
authors.forename: R O
authors.initials: RO
authors.lastname: Atlas
authors.forename: K J
authors.initials: KJ
authors.lastname: Jones
authors.forename: J
authors.initials: J
authors.lastname: Balducci
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D002404:Catheterization; D020070:Cervical Ripening / Q000187:drug effects*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007751:Labor, Induced; D016595:Misoprostol / Q000008:administration & dosage / Q000494:pharmacology*; D010120:Oxytocics / Q000008:administration & dosage / Q000494:pharmacology*; D011247:Pregnancy; D013997:Time Factors
chemical_list: D010120:Oxytocics; D016595:Misoprostol