LOW DOSE INTRAVAGINAL MISOPROSTOL VERSUS INTRACERVICAL BALOON CATHETER FOR PRE-INDUCTION CERVICAL RIPENING

Abstract

Background: The efficacy and safety of low dose misoprostol as a ripening agent
compared to the widely used balloon catheter in developing countries is undetermined.
Objective: To compare the safety and efficacy of a low dose intravaginal misoprostol
and intracervical Foley’s catheter for cervical ripening.
Design: A prospective randomized controlled trial.
Setting: Zonal General Hospital, Kwale, Nigeria from June 1, 1998 to May 30, 2001.
Methods: Candidates for pre-induction cervical ripening were randomized to receive
either 250 mcg of intravaginal misoprostol every four hours (n = 60) or intracervical
Foley’s catheter (n = 61).
Main outcome measures: Failure to achieve cervical ripening within 24 hours, need for
augmentation, maternal and foetal complications.
Results: Failure to achieve cervical ripening within two hours was reduced with
misoprostol (Relative Risk [RR] 0.63, 95% Confidence Interval [CI] 0.43 - 0.92). Need
for oxytocin augmentation was less in the misoprostol group (RR 0.76, 95% CI 0.64
to 0.91). No significant differences existed in rates for uterine hyperstimulation,
Caesarean section, maternal and neonatal morbidity.
Conclusion: Intravaginal misoprostol in a low dose was compared to intracervical balloon
catheter for pre-induction ripening of the cervix.