title: Induction of Labor Using a Foley Catheter or Misoprostol: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  Induction of labor is a widely used obstetric intervention, occurring in one in four pregnancies. When the cervix is unfavorable, still many different induction methods are used.
  
  
  OBJECTIVE
  We compared Foley catheter alone to different misoprostol dosages and administration routes, and the combination of Foley catheter with misoprostol.
  
  
  METHODS
  We reviewed the literature on the best induction method regarding their safety and effectiveness, using the outcome measures hyperstimulation, fetal distress, neonatal morbidity and mortality as well as cesarean delivery, vaginal instrumental delivery, and maternal morbidity. We searched Pubmed, Cochrane, and Web of Science from January 1, 1980 to February 12, 2016. Twenty-two randomized controlled trials (RCTs) were included, comparing Foley catheter with or without misoprostol to misoprostol alone (both vaginal and oral) for induction of labor (5,015 women).
  
  
  RESULTS
  Most included studies were underpowered to detect differences in safety outcomes, as the majority are powered for time to delivery or cesarean delivery. Meta-analysis of these studies does not allow assessment of the safety profile of Foley catheter compared to misoprostol (any dose, any administration route) with sufficient power. For the safety outcomes of the total group of Foley catheter versus misoprostol (any dose, any administration route) (17 studies, 4,234 women) we found that Foley catheter results in less hyperstimulation compared to misoprostol (2% versus 4%; risk ratio [RR], 0.54; 95% confidence interval [CI], 0.37-0.79) and fewer cesarean deliveries for nonreassuring fetal heart rate, 5% vs 7%; RR, 0.72; 95% CI, 0.55-0.95; while there were no statistically significant differences in neonatal outcomes. The total number of cesarean deliveries was 26% versus 22% (RR, 1.16; 95% CI, 1.00-1.34). There were fewer vaginal instrumental deliveries with a Foley catheter compared to misoprostol (10% vs 14%; RR, 0.74; 95% CI, 0.60-0.91). Foley catheter with misoprostol compared to misoprostol alone (any dose, any administration route) (7 studies, 1,073 women) resulted in less hyperstimulation than misoprostol alone (17% vs 23%; RR, 0.71; 95% CI, 0.52-0.97). Cesarean deliveries for nonreassuring fetal heart rate were comparable (7% vs 9%; RR, 0.79; 95% CI, 0.51-1.22). Neonatal outcomes were infrequently reported. The total number of cesarean deliveries was 34% versus 34% (RR, 1.01; 95% CI, 0.86-1.19).
  
  
  CONCLUSIONS
  In women with an unripe cervix at term, Foley catheter seems to have a better safety profile than misoprostol (any dose, any administration route) for induction of labor. Larger studies are needed to investigate the safety profile of a Foley catheter compared to separate dosing and administration regimens of misoprostol.
authors: Resident, Department of Obstetrics, Leiden University Medical Centre (LUMC), Leiden, the Netherlands.
authors: Mieke L G
authors: ML
authors: Ten Eikelder
authors: Resident, Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands.
authors: Kelly
authors: K
authors: Mast
authors: Librarian, Medical Library, Groene hartZiekenhuis, Gouda, the Netherlands.
authors: Annemarie
authors: A
authors: van der Velden
authors: Professor, Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors: Kitty W M
authors: KW
authors: Bloemenkamp
authors: Professor, The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, and the South Australian Health and Medical Research Institute, Adelaide, Australia.
authors: Ben W
authors: BW
authors: Mol
mesh_terms: D002404:Catheterization / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods; D016595:Misoprostol / Q000494:pharmacology*; D010120:Oxytocics / Q000494:pharmacology; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment
chemical_list: D010120:Oxytocics; D016595:Misoprostol