Preinduction cervical ripening: A comparison of intracervical prostaglandin E2 gel versus the Foley catheter

OBJECTIVE: Both prostaglandin E2 gel and an intracervical balloon catheter have been shown to be effective for cervical ripening. The purpose of this study is to compare the efficacy of intracervical prostaglandin E2 gel with an intracervical Foley catheter for preinduction cervical ripening. STUDY DESIGN: A randomized, prospective study was conducted in the Maternity Care Center at the Foothills Hospital at Calgary, Alberta, Canada. Patients with a Bishop score ≤4 and meeting inclusion and exclusion criteria were included. Thirty patients were randomized to receive prostaglandin E2 gel and 36 to receive an intracervical Foley catheter on the evening before induction. Induction then proceeded thue following morning by the preferred method of the attending physician. RESULTS: The groups were comparable with respect to maternal age, parity, gestational age, reason for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (4.1 ± 0.4 and 4.8 ± 0.5, respectively, p< 0.001); however, there was no significant difference between the groups There was no significant difference in side effect profile, intrapartum complications, or delivery mode. Six cesarean sections (17.6%) were performed in the Foley group and seven (25%) in the prostaglandin E2 gel group (not significant). The induction-to-delivery interval was 16.0 ± 1.7 hours in the Foley group and 21.5 ± 3.2 hours in the prostaglandin E2 gel group (p = 0.014). Apgar scores, cord gases, and neonatal birth weight showed no difference between the group. CONCLUSION: This study has shown that for preinduction cervical ripening there is no difference in efficacy between intracervical prostaglandin E2 gel or an intracervical Foley catheter.