Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 4 ( July-August, 2022 ) > List of Articles

Original Article

Foley's Catheter and Vaginal Misoprostol vs Vaginal Misoprostol Alone for Labor Induction

Shikha Manohar Toshniwal, Saunitra Inamdar, Sakshi Rajesh Sharma

Keywords : Bishop's score, Foleys catheter, Labor induction misoprostol

Citation Information : Toshniwal SM, Inamdar S, Sharma SR. Foley's Catheter and Vaginal Misoprostol vs Vaginal Misoprostol Alone for Labor Induction. J South Asian Feder Obs Gynae 2022; 14 (4):381-386.

DOI: 10.5005/jp-journals-10006-2094

License: CC BY-NC 4.0

Published Online: 22-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Objectives: To compare the efficacy of transcervical Foley's catheter and vaginal misoprostol vs vaginal misoprostol alone in the induction of labor at or after 39 weeks of gestation. Methods: This randomized comparative study included 110 women with a singleton gestation, vertex presentation, gestation>39 weeks, Bishop's score <6, and no contraindication for normal vaginal delivery. General examination, systemic examination, obstetric examination, and pelvic examination were done to note the Bishop's score and adequacy of pelvis, and the patients were grouped in two categories: Group A: Tablet Misoprostol 25 μg and Group B: Tablet Misoprostol 25 μg plus Foley's catheter (No. 16). Results: Mean ± SD of induction to delivery interval (hours) in group B (14.6 ± 2.26) was significantly lesser as compared to group A (17.9 ± 2.82) (p value 0.05). The intrapartum complications were comparable between groups A and B (fever, diarrhea, tachysystole, hypertonic contraction, hyperstimulation syndrome, p = 0.495). The postpartum complications were comparable between groups A and B (atonic PPH, traumatic PPH: p >0.05). The abnormal heart rate (bradycardia: 3.64% vs 5.45%, p = 1 and persistent tachycardia: 3.64% vs 1.82%, p = 1) and presence of meconium-stained liquor (7.27% vs 5.45%, p = 1) were comparable between groups A and B. Group A and B had comparable neonatal outcomes [NICU admission, reason for NICU admission, early neonatal death, mean Apgar at 1 minute (7.8 vs 7.85, p = 0.524), and Apgar at 5 minutes (8.85 vs 8.95, p = 0.242)]. Conclusion: To conclude, the combination of Foley's catheter + vaginal misoprostol resulted in significant improvement in Bishop score and shorter induction to delivery interval than vaginal misoprostol alone. Thus, it is more preferable to use a combination of vaginal misoprostol and Foley's catheter for induction of labor. However, both techniques were equally effective in terms of mode of delivery, indication for cesarean section, intrapartum and postpartum complications, abnormal heart rate, meconium-stained liquor, and neonatal outcomes.

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  1. Marconi AM. Recent advances in the induction of labor. F1000Res 2019;8:F1000 Faculty Rev-1829. DOI: 10.12688/f1000research.17587.1.
  2. Caughey AB, Sundaram V, Kaimal AJ, et al. Systematic review: elective induction of labor versus expectant management of pregnancy. Ann Intern Med 2009;151(4):252–263, W53-63. DOI: 10.7326/0003-4819-151-4-200908180-00007.
  3. Leduc D, Biringer A, Lee L, et al. Induction of labour. J Obstet Gynaecol Can 2013;35(9):840–857. DOI: 10.1016/S1701-2163(15)30842-2.
  4. FOGSI & ICOG Good Clinical Practice Recommendations - The Federation of Obstetric & Gynecological Societies of India [Internet]. Available from:
  5. Kolkman DGE, Verhoeven CJM, Brinkhorst SJ, et al. The Bishop score as a predictor of labor induction success: a systematic review. Am J Perinatol 2013;30(8):625–630. DOI: 10.1055/s-0032-1331024.
  6. Wormer KC, Bauer A, Williford AE. Bishop Score. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Available from:
  7. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009;114(2 Pt 1):386–397. DOI: 10.1097/AOG.0b013e3181b48ef5.
  8. Akyol A, Karademir Ö, Gedikbafl A, et al. The role of the Bishop score for successful labor induction. Perinatal J 2007;15(1):9. Corpus ID: 172133540.
  9. Bakker R, Pierce S, Myers D. The role of prostaglandins E1 and E2, dinoprostone, and misoprostol in cervical ripening and the induction of labor: a mechanistic approach. Arch Gynecol Obstet 2017;296(2):167–179. DOI: 10.1007/s00404-017-4418-5.
  10. Bhatiyani BR, Gandhewar MR, Kapsikar S, et al. A study comparing vaginal misoprostol alone with vaginal misoprostol in combination with Foley catheter for cervical ripening and labour induction. Int J Reprod, Contracep, Obstet Gynecol 2017;6(2):485. DOI: 10.18203/2320-1770.ijrcog20170367.
  11. Murmu S, Dwivedi C. A comparative study of intracervical Foley's catheter and intracervical PGE2 gel for pre-induction cervical ripening. Int J Reprod, Contracep, Obstet Gynecol 2018;7(8):3122–3125. DOI: 10.18203/2320-1770.ijrcog20183302.
  12. An overview of the past, current and future trends for cervical ripening in induction of labour – Chodankar – 2017 – The Obstetrician & Gynaecologist – Wiley Online Library. Available from:
  13. Davalagi V, Neeta LG. Efficacy of vaginal Misoprostol versus transcervical Foley's catheter and vaginal Misoprostol in induction of labor. Int J Reprod, Contracep, Obstet Gynecol 2019;8(4):1341–1346. DOI: 10.18203/2320-1770.ijrcog20190982.
  14. Carbone JF, Tuuli MG, Fogertey PJ, et al. Combination of Foley bulb and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and labor induction: a randomized controlled trial. Obstet Gynecol 2013;121(2 Pt 1):247–252. DOI: 10.1097/AOG.0b013e31827e5dca.
  15. Santosh, Kaur P, Kaur A, et al. A comparative study of combination of intracervical foley's catheter and intravaginal misoprostol versus intravaginal misoprostol alone for induction of labour. Indian J Obstet Gynecol Res 2020 Dec 15;5(1):131–135.
  16. Hill JB, Thigpen BD, Bofill JA, et al. A randomized clinical trial comparing vaginal misoprostol versus cervical Foley plus oral misoprostol for cervical ripening and labor induction. Am J Perinatol 2009;26(1):33–38. DOI: 10.1055/s-0028-1091396.
  17. Chung JH, Huang WH, Rumney PJ, et al. A prospective randomized controlled trial that compared misoprostol, Foley catheter, and combination misoprostol-Foley catheter for labor induction. Am J Obstet Gynecol 2003;189(4):1031–1035. DOI: 10.1067/s0002-9378(03)00842-1.
  18. Kashanian M, Akbarian AR, Fekrat M. Cervical ripening and induction of labor with intravaginal misoprostol and Foley catheter cervical traction. Int J Gynaecol Obstet 2006;92(1):79–80. DOI: 10.1016/j.ijgo.2005.09.010.
  19. Osoti A, Kibii DK, Tong TMK, et al. Effect of extra-amniotic Foley's catheter and vaginal misoprostol versus vaginal misoprostol alone on cervical ripening and induction of labor in Kenya, a randomized controlled trial. BMC Pregnancy Childbirth 2018;18(1):300. DOI: 10.1186/s12884-018-1793-2.
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