Meta-analysis of Foley catheter plus misoprostol versus misoprostol alone for cervical ripening

Background: The effectiveness of Foley catheter plus misoprostol for cervical ripening has not been convincingly shown in trials.

Objectives: To summarize the evidence comparing Foley catheter plus misoprostol versus misoprostol alone for cervical ripening.

Search strategy: Embase, Medline, and Cochrane Collaboration databases were searched with the terms "Foley catheter," "misoprostol," "cervical ripening," and "labor induction."

Selection criteria: Randomized controlled trials comparing the methods of cervical ripening for delivery of a viable fetus were included.

Data collection and analysis: Study characteristics, quality, and outcomes were recorded. Random-effects models were used to combine data.

Main results: Eight trials were included, with 1153 patients overall. In a pooled analysis of seven high-quality studies, the combination group had a decreased time to delivery (mean difference -2.36 hours, 95% confidence interval [CI] -4.07 to -0.66; P=0.007). Risk of chorioamnionitis was significantly increased in the combination group (risk ratio [RR] 2.07, 95% CI 1.04-4.13; P=0.04), and that of tachysystole with fetal heart rate changes was decreased (RR 0.58, 95% CI 0.38-0.91; P=0.02). Frequency of cesarean did not differ (P=0.77).

Conclusions: The combined use of Foley catheter and misoprostol results in a reduced time to delivery, a reduced frequency tachysystole with fetal heart rate changes, and an increased incidence of chorioamnionitis.