COMPARATIVE STUDY BETWEEN INTRACERVICAL DOUBLE FOLEYS CATHETER PLUS MISOPROSTOL AND INTRAVAGINAL MISOPROSTOL ALONE FOR INDUCTION OF LABOUR

Abstract

Background Labour induction, constituting approximately 25% of deliveries, involves stimulating uterine contractions to initiate vaginal delivery. One of the approaches involves the use of pharmacological drugs, which include prostaglandins like dinoprostone, misoprostol, and oxytocin, as well as medical equipment, which include saline drip and balloon catheters. Treatments that do not include the use of pharmaceuticals include amniotomy and membrane peeling. The cervix's initial condition significantly impacts induction success, with optimal outcomes seen in already softened and effaced cervices. The Foley balloon catheter is effective for cervical ripening, offering advantages such as lower uterine tachysystole risk, reduced cost, and easy reversibility. A comparison was made between the usage of 25 micrograms of intravaginal misoprostol and the usage of intracervical twin Foley catheters paired with misoprostol to induce labor. The research also compared the results for both the mother and the fetus. Materials and Methodology At the RLJH hospital, the research comprised 166 women who were experiencing their first pregnancy and had gestational ages ranging from 37 to 42 weeks. Comprehensive demographic, obstetric, and medical histories were recorded. Gestational age was clinically confirmed, and routine investigations were conducted. Two groups of women were blindly randomized to obtain either a XXII | P a g e Double Foley's Catheter with Misoprostol or Misoprostol alone. These women had a reactive NST and a modified Bishop score of just five. In the Double Foley group, two inflated catheters and intravaginal misoprostol were administered every six hours (up to four doses). On the other hand, the Misoprostol group was given 25 micrograms of misoprostol every six hours until the cervix was favorable. The following were some of the outcomes that were measured: vaginal birth rates, induction-to-active-phase and delivery intervals, oxytocin augmentation, delivery mode, APGAR ratings, NICU admissions, anomalies in fetal heart rate, and maternal problems such as uterine hyperstimulation. Results The mean age of participants was similar between groups (25.78 years for the combined group and 24.91 years for the misoprostol group), with most participants aged 21-25 years. Gestational ages were comparable, with more early-term pregnancies in the combined group and more full-term pregnancies in the misoprostol group. Prolonged pregnancy was the most common induction reason. The combined group required fewer misoprostol doses and had shorter induction-to-active-phase (mean 7.24 hours) and delivery times (mean 13.13 hours) compared to the misoprostol group (16.28 and 18.14 hours, respectively). The vaginal delivery was more usual in the combined group (59. 0% vs. 38. 6%) while caesarean sections were less frequent (28. 9% vs. 46. 9%). There were no noteworthy differences in neonatal results and maternal adverse events, although postpartum hemorrhage appeared slightly higher in the misoprostol group. These outcomes suggest that the coordinated treatment strategy is efficient, thus reducing the labor and enhancing the vaginal delivery proportions. XXIII | P a g e Conclusion Based on the study, it can be suggested that the effectiveness of the treatment regimens of induction of labor with misoprostol only is lower than the effectiveness of the treatment regimens with the Double Foley’s Catheter and misoprostol combined, therefore giving better outcomes in shorter induction time, increased rates of vaginal delivery and lower rates of CS - Caesarean section. Since the two groups did not vary in terms of newborn outcomes or maternal problems, the combination approach was superior.