Cervical ripening in mid-trimester abortion by intravaginal misoprostol versus saline inflated intracervical Foley's catheter

Abstract EN

Objective : To compare between Foley's catheter inflated with Saline and misoprostol for cervical ripening in cases of mid-trimester abortion.

Setting : The study was done in OB / Gyn department of Al-Azhar University Hospitals (El-Hussein and Sayed Galal).

Patients and methods : This is a prospective randomized control study done on 50 patients from November 2003 to April 2004, All were at between 14 and 20 weeks gestation and admitted for induction of mid-trirnester abortion due to missed abortion.

They were randomly subdivided into 2 groups; Group (A) : (25 patients) for each of them; a size 14 Foley's catheter is inserted above the internal os and the balloon is inflated by 25 ml saline for a period of 12 hours.

Group (B) (25 patients) for each them; 200mcg misoprostol will be inserted in the posterior vaginal fornix for a period of 12 hours.

Results: The increase in cervical canal diameter in group (A) (25.3mm) was highly significantly higher than in group (B) (7.5mm) (P < 0.0001) the gain in cervical softness was significantly higher in group A (88%) than in group B (68%) (P value < 0.001).

The onset of uterine contraction was significantly more rapid in group A (with mean ± SD : 5.03 ± 1.23 hours) than in group B (with mean ± SD :7.12 ± 1.74 hours) (p.

value < 0.05).

Group A had a significantly shorter insertion -expulsion interval (with mean ± SD : 10.2 ± 2.2 hours) compared to group B (with mean ± SD :18.7 ± 3.8 hours) (P.

value < 0.001).

On the other hand group A had a significant increased degree of vaginal bleeding than group B (P.

value < 0.01).

Also group A had a significantly higher incidence of the need to post - expulsion evacuation and curettage (36 %) than group B (16 %) (P.

value < 0.05).

There was no cases of fever during the period of insertion in both groups while the catheter group has a significant increase in the incidence of post-abortive fever (20 %) than in misoprostol group (0 %)(P < 0.05).

Conclusion : Foley's catheter has a rapid action than misoprostol regarding cervical ripening.

But on the other hand, it has many disadvantages as more increased incidence of post-abortive pyrexia vaginal bleeding and need to evacuation & curettage than misoprostol