Vol 91, No 11 (2020)
Research paper
Published online: 2020-09-18

open access

Page views 1121
Article views/downloads 1164
Get Citation

Connect on Social Media

Connect on Social Media

Misoprostol vaginal insert and Foley catheter in labour induction — single center retrospective observational study of obstetrical outcome

Jakub Mlodawski1, Marta Mlodawska1, Justyna Plusajska1, Jagoda Galuszewska2, Kamila Glijer2, Stanislaw Gluszek1
Pubmed: 33301165
Ginekol Pol 2020;91(11):700-703.


Objectives: Induction of labour is one of the most common procedures used in obstetrics and its prevalence tends to
increase. In patients with an unripe cervix (Bishop score < 7) pre-induction procedures are used before the start of oxytocin
induction. Currently there is no consensus among scientific societies on the optimal way of pre-induction. We have conducted
a single-centre retrospective observational study comparing obstetric induction results of patients after 37 weeks
of gestation who were pre-induced with misoprostol vaginal insert (MVI) with 200 μg of misoprostol (Misodel — Ferring
Pharmaceuticals Poland) or Foley catheter (20 F, 60 mL baloon).
Material and methods: We have reviewed the medical records of 503 patients (group A pre-induced MVI — 135 patients,
group B pre-induced Foley catheter — 368 patients) who were in a single, full-term pregnancy, pre-induced due to unripe
cervixes (Bishop score < 7) with a Foley catheter or Misodel (MVI 200 μg). We compared obstetric results between groups.
Results: Group A patients had a lower chance of using oxytocin in labour induction/augmentation (OR = 0.21 95%
CI = 0.13–0.32), and a greater chance of surgical delivery by caesarean section (OR = 2.14 95% CI = 1.42–3.23) and vacuum
extraction (OR = 3.29 95% CI = 1.08–10.00). Group A patients also had a greater chance of abnormal CTG (OR = 2.66 95%
CI = 1.5–4.7) compared to group B. The groups did not differ in terms of meconium stained amniotic fluid and postpartum
haemorrhage. The percentage of children born with a pH from umbilical cord blood < 7.2 and < 7.1 and newborns of
medium general condition (Apgar 4–7) did not differ between the groups.
Conclusions: Neonatological results of children from Foley catheters and MVI induced delivery do not differ. Patients
pre-induced with MVI rarely require labour augmentation with oxytocin. MVI-preinduced patients have a better chance of
having a delivery by CS or VE compared to the Foley catheter.

Article available in PDF format

View PDF Download PDF file


  1. World Health Organization Dept. of Reproductive Health and Research. WHO recommendations for induction of labour. t. 2011.
  2. Osterman MJK, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief. 2014(155): 1–8.
  3. Bomba-Opoń D, Drews K, Huras H, et al. Polish Gynecological Society Recommendations for Labor Induction. Ginekol Pol. 2017; 88(4): 224–234.
  4. Zeitlin J, Blondel B, Alexander S, et al. PERISTAT Group. Variation in rates of postterm birth in Europe: reality or artefact? BJOG. 2007; 114(9): 1097–1103.
  5. Grobman WA, Rice MM, Reddy UM, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med. 2018; 379(6): 513–523.
  6. Society of Maternal-Fetal (SMFM) Publications. MFM Statement on Elective Induction of Labor in Low-Risk Nulliparous Women at Term: the ARRIVE Trial. Am J Obstet Gynecol. 2019; 221(1): B2.
  7. Joyce A, Martin MP, Brady E, et al. ivision of Vital Statistics. Births: Final Data for 2017. National VitalStatistics Reports. 2018; 67(8).
  8. Bajcarczyk R, Florek R. Determinants of procreative attitudes of Polish women over the years. Medical Studies. 2018; 34(3): 252–258.
  9. Wing DA, Brown R, Plante LA, et al. Misoprostol vaginal insert and time to vaginal delivery: a randomized controlled trial. Obstet Gynecol. 2013; 122(2 Pt 1): 201–209.
  10. Chen W, Xue J, Peprah MK, et al. A systematic review and network meta-analysis comparing the use of Foley catheters, misoprostol, and dinoprostone for cervical ripening in the induction of labour. BJOG. 2016; 123(3): 346–354.
  11. Bierut A, Dowgiałło-Smolarczyk J, Pieniążek I, et al. Misoprostol Vaginal Insert in Labor Induction: A Cost-Consequences Model for 5 European Countries-An Economic Evaluation Supported with Literature Review and Retrospective Data Collection. Adv Ther. 2016; 33(10): 1755–1770.
  12. Bucher HC, Griffith LE, Guyatt GH, et al. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol. 1997; 50(6): 683–691.
  13. Jagielska I, Kazdepka-Ziemińska A, Tyloch M, et al. Obstetric outcomes of pre-induction of labor with a 200 μg misoprostol vaginal insert. Ginekol Pol. 2017; 88(11): 606–612.
  14. Meier K, Parrish J, D'Souza R. Prediction models for determining the success of labor induction: A systematic review. Acta Obstet Gynecol Scand. 2019; 98(9): 1100–1112.
  15. Mlodawski J, Mlodawska M, Galuszewska J, et al. Is Unfavourable Cervix prior to Labor Induction Risk for Adverse Obstetrical Outcome in Time of Universal Ripening Agents Usage? Single Center Retrospective Observational Study. Journal of Pregnancy. 2020: 5.