- Inducing labour: comparison of pharmacological and mechanical approaches
J.A.M. van der Post
- Award date
- 8 September 2016
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
Induction of labour is an obstetric intervention that artiﬁcially initiates the process of effacement of the cervix, dilatation, uterine contractions, and eventually delivery of the baby. 25% of women in high-resource settings have labour induced. In women with an unfavourable cervix, induction of labour starts with cervical ripening, which can be achieved with mechanical methods, such as a Foley catheter, or pharmacologically, with prostaglandin E1 or E2 analogues. When prostaglandin preparations were introduced for induction of labour in the 70s and 80s, older methods such as the Foley catheter were rapidly replaced, without confirmation of equal or better safety and effectiveness profiles of the new drugs. In the first PROBAAT study, Jozwiak et al showed that the Foley catheter had a better safety profile than prostaglandin E2 preparations.
In this thesis, we investigated the safety and effectiveness profile of the Foley catheter compared to prostaglandin E1 (misoprostol). We performed randomized controlled trials on Foley catheter versus vaginal misoprostol and on Foley catheter versus oral misoprostol. A review and meta-analysis on the current literature comparing Foley catheter to misoprostol was also performed.
Foley catheter has a better safety profile than vaginal administration of misoprostol (all dosages), and a comparable safety profile to 50 microgram oral misoprostol. Costs and women’s preferences are comparable between Foley catheter and oral misoprostol. Foley catheter in an outpatient setting could reduce costs and might be preferable by the women.
In conclusion, Foley catheter and oral misoprostol should be considered as first choice for induction of labour with an unripe cervix.
- Research conducted at: Universiteit van Amsterdam
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