Cervical ripening and induction of labor with misoprostol, dinoprostone gel, and a foley catheter: A randomized trial of 3 techniques

Objective: The purpose of this study was to compare the efficacy of 3 different techniques of cervical ripening and induction. Study Design: Patients who required cervical ripening and induction were randomized to one of 3 groups: (1) supracervical Foley catheter and intravaginal dinoprostone gel, (2) supracervical Foley catheter and 100 μg oral doses of misoprostol, or (3) serial 100-μg oral doses of misoprostol. Intravenous oxytocin was administered when a protraction disorder of labor was identified. Results: There were 339 women randomized. There was no significant difference in the time from first intervention to delivery in the 3 groups (P = .546). In each group, a similar percentage of women required oxytocin (P = .103). The rates of cesarean delivery were equivalent among the groups (P = .722). Rates of tachysystole were high but statistically equivalent among the 3 groups. There were no significant differences in Apgar scores or umbilical artery pH. Conclusion: Oral 100 μg serial doses of misoprostol, with or without the use of a supracervical Foley catheter, were equivalent to the use of a supracervical Foley catheter and serial 4-mg doses of dinoprostone gel for cervical ripening and the induction of labor. (Am J Obstet Gynecol 2002;186:1124-9.)