Comparison of vaginal misoprostol with foley catheter for cervical ripening and induction of labor.

At times, despite an unripe cervix, induction of labor may be needed. In these cases, a safe and suitable method should be considered for cervical ripening and pregnancy termination. The aim of this study is the comparison of vaginal misoprostol with Foley catheter for cervical ripening and induction of labor. This randomized clinical trial was performed on 108 pregnant women who had referred to the teaching hospitals of Mashhad University of Medical Sciences during a time period of September 2007 to March 2008. These women were randomly divided into two groups: Misoprostol (including 49 patients) and Foley catheter (including 59 patients). For the first group, 25 microgram vaginal misoprostol was administered every 4 h up to maximum 6 doses. For the second group, Foley catheter 18 F, inflated with 50 cc of sterile water, was placed through the internal os of the cervix. Data was analyzed using SPSS software. p < 0.05 was considered statistically significant. Two groups were similar in the view of demographic characteristics, cesarean indications, maternal and fetal outcomes and neonatal outcomes. Vaginal delivery was significantly higher in misoprostol group (89.9 vs. 62.7, p < 0.01). The mean of delivery time was significantly shorter in misoprostol group (11.08 ± 5.6 vs. 13.6 ± 16.0 h, p < 0.05). In the cases of pregnancy termination and unripe cervix, two methods of misoprostol and Foley catheter were considered suitable, but it seemed that misoprostol decreases the delivery time and was needed for the cesarean section.

Misoprostol alone or in combination with methotrexate for termination of pregnancy at first trimester.

Abortion is an important problem in obstetrics throughout the world. The common and standard method for pregnancy termination at first trimester is surgery (curettage). Nowadays, an effective method of pregnancy termination at first trimester is medical treatments. The aim of this study is to compare misoprostol alone or in combination with methotrexate for pregnancy termination at first trimester. This study is a randomized clinical trial. A total of 200 pregnant women at first trimester were randomizedly divided into two groups for termination of pregnancy. The first group received 800 µg vaginal misoprostol. If conceptus residual remained, the same dose of misoprostol was repeated. The second group received 50 mg/m² intramuscular methotrexate, and then 800 µg vaginal misoprostol was administered after 72 h. If conceptus residual remained, the same dose of misoprostol was repeated after 24 h. Abdominal ultrasonography was performed at seventh day for both groups. Should conceptus residual remained or if pregnancy continued, curettage was performed. The results were analyzed statistically in terms of chi-square, and student's t-test, using the SPSS software. A P-value equal or smaller than 0.05, was considered statistically significant. In this study, 83% of the first group and 81% of the second group had successful abortion. There was a significant correlation between the dose of misoprostol and abortion (P = 0.001) and between type of pregnancy and need for curettage (P < 0.000) in both groups, but there was no significant correlation between gestational age and the numberof doses administered (P = 0.932).In conclusion it seems that pregnancy termination by misoprostol alone or in combination with methotrexate is a safe and cost-effective method.