Comparison and Combinations of Methods for Cervical Ripening and Induction of Labor
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Can someone please share the details about comparison and combinations of Methods for Cervical Ripening and Induction of Labor?
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@quincy There is no clear consensus on what method is the best for cervical ripening and induction of labor. There have been multiple studies comparing individual methods as well as combinations of various methods. A few will be reviewed below.
Of note, the obstetric care consensus on the safe prevention of the primary cesarean delivery made the recommendation for cervical ripening methods to be implemented in women undergoing induction of labor with an unfavorable cervix. The obstetric care consensus is a joint statement from both the American College of Obstetricians and Gynecologist and the Society for Maternal Fetal Medicine.
Misoprostol versus Transcervical Foley Catheter
A randomized controlled trial compared induction of labor with misoprostol to transcervical Foley catheter. There was no difference in cesarean delivery rate or time from induction to delivery between groups. Additionally, there was no difference in maternal or neonatal infections.
A Cochrane review comparing prostaglandins with mechanical methods found no difference in cesarean delivery rate. Additionally, it was noted that there was less uterine tachysystole with fetal heart rate changes with mechanical methods compared to prostaglandins.
Misoprostol versus Oxytocin
A randomized controlled trial compared induction of labor with misoprostol to oxytocin. All women included started with an unfavorable cervix. There was no difference in cesarean delivery rates, maternal complications or neonatal outcomes between groups. However, the time from induction to delivery was shorter in the oxytocin group.
Transcervical Foley Catheter versus Oxytocin
A Cochrane review found reduction in cesarean delivery rate when transcervical Foley catheter was used versus oxytocin. Uterine tachysystole with fetal heart rate changes was not reported. There was no difference in maternal complications but neonatal morbidity was not reported.
Transcervical Foley Catheter with Oxytocin versus Misoprostol
A randomized control trial compared induction of labor in nulliparous women with an unfavorable cervix using transcervical Foley catheter with oxytocin versus misoprostol. There was no difference in cesarean delivery rates, maternal complications or neonatal outcomes between groups. The time from induction to delivery was shorter in the transcervical Foley catheter and oxytocin group.
Transcervical Foley Catheter with Misoprostol versus Misoprostol
A randomized control trial compared induction of labor with transcervical Foley catheter plus misoprostol to misoprostol alone. There was no difference in cesarean delivery rates nor maternal complications or neonatal outcomes between groups. The time from induction to delivery was shorter in the transcervical Foley catheter with misoprostol group.
Transcervical Foley Catheter with Oxytocin versus Transcervical Foley Catheter
A randomized control trial compared induction of labor with transcervical Foley catheter with oxytocin to transcervical Foley catheter alone. There was no difference in cesarean delivery rates or time from induction to delivery between the two groups.