The Comparison of Dinoprostone Gel and Foley’s Catheter for the Induction of Labour

BACKGROUND: For women who do not progress into spontaneous labour cervical ripening and induction of labour is often required.Induction of labour must be safe, effective and preferably non invasive. Pharmacological method commonly for induction is prostaglandin gel. The mechanical action of foley catheter has been used for induction of labour.The mechanical action of foleys catheter strips the fetal membranes from lower uterine segment and causes rupture of lysosomes.The lytic enzymes act on phospholipase to form arachidonic acid which is converted to prostaglandin improving the consistency and effacement of cervix.Advantage over pharmacological methods -reduced side effects and cost effective. OBJECTIVES: The purpose of this study is to compare the efficacy of foley’s catheter with intracervical dinoprostone gel for preinduction cervical ripening. The induction delivery interval ,maternal and fetal outcomes and need for augmentation of labour in these two groups are to be compared MATERIALS AND METHODS: Prospective randomised study. Select 200 pregnant women admitted in labour for induction of labour are to be divided into two goups Group-1 administerd intracervical extraamniotic foley catheter inflated with 50 ml normal saline. Group 2-intracervical dinoprostone gel. INCLUSION CRITERIA: Term pregnant women, Singleton pregnancy, Cephalic presentation, Bishop score < 3, Post dated pregnancies, Mild oligohydramnios, Placenta praevia, Malpresentations, Scarred uterus, Active genital infection, Multiple pregnancy, Antepartum haemorrhage, PROM, Prolapsed umblical cord. PRIMARY OUTCOME: Post induction bishop score was assesed after 6 hours of administation of gel. And after 12 hours of foley induction. SECONDARY OUTCOME: Improvement of bishop’s score induction delivery interval, mode of delivery and feto maternal outcome were noted. RESULTS: The present study was conducted on 200 pregnant females at term who were divided into 2 groups: IOL in the first group was done with dinoprostone gel (100 subjects); IOL in the second group was done using Foley’s catheter. CONCLUSION: 1. In our study, dinoprostone vaginal gel was associated with shorter induction to delivery interval compared to Foley’s catheter. 2. Both foleys and dinoprostone gel were associated with higher rates of spontaneous vaginal delivery and both were found equally efficacious in induction and significant reduction in cesarean was found in both groups. 3. Both methods of induction appeared to be safe, with no cases of apgar score < 7, other complications of induction like tachysystole and infections were also not reported in this study 4. There was a reduced need for oxytocin augmentation in dinoprostone vaginal gel compared to Foley’s catheter. There was similar need for augmentation by ARM in both the groups. 5. There were no significant post-partum complications in both the groups, except PPH,which was marginally higher in gel compared to foleys. 6. There were no neonatal or maternal deaths in both the groups.