Abstract

The goal of obstetrics is a pregnancy that results in a healthy infant and a healthy minimally traumatized mother. Much of the art of good obstetric care involves the delicate balance of avoiding cesarean delivery with all its attendant complications. Planned pre-induction cervical ripening and induction of labor has become an established part of modern obstetric practice. Different methods used for the induction of labor in women with an unfavorable bishops score are, mechanical methods such as trans cervical extra-amniotic Foley‘s catheter(FC)insertion, intra cervical balloon catheter and medical methods like vaginal prostaglandin(PGE2) and misoprostol(PGE1)are used for IOL in women with an unfavorable cervix for pre-induction cervical priming. The present prospective study was conducted in a teritiary care hospital after obtaining clearance from institutional ethical committee with no GMC/IEC/140/2019 to compare the efficacy of intra cervical Foleys catheter with Dinoprostone gel (PGE2) in cervical ripening and induction of labor, maternal and neonatal outcome. Maternal outcome compared in terms of pre-induction bishop score and change in bishop score after induction, need for reinstallation and augmentation of labor, the interval between intervention and delivery, mode of delivery, indication for cesarean section, induction delivery interval. Neonatal outcome compared in terms of apgar score at 1min and 5min, perinatal morbidity and mortality. Two hundred antenatal mothers with bishop score<5were randomly allocated to be induced with intracervical foleys catheter (group A) and PGE2 gel (group B). In this study, both Foley’s balloon dilatation and PGE2 gel group had patients of almost similar age group, parity, and gestational age. In the present study, in both the groups (foleys and PGE2 gel groups), post-datism was the commonest indication for induction- 52% and 45%, respectively, followed by pre-eclampsia-19%and 32%. The mean improvement in Bishop score was higher in the PGE2 gel group when compared to the Foley’s. The need for oxytocin augmentation to deliver was higher with Foley’s balloon dilatation when compared to the PGE2 gel group. The mean induction delivery interval in Foley’s group was 13.17hours. The mean induction delivery interval in the PGE2 gel group was 11.43hours. In both the groups, the maternal and fetal outcomes are found to be similar. In both the groups, the rate of normal vaginal and cesarean section delivery was also found to be equal. This study shows that prostaglandin E2 gel is a better and more effective agent than foley’s balloon dilatation in cervical ripening and induction of labour