Robert L. Barbieri, MD reviewing ten Eikelder MLG et al. Lancet 2016 Feb 2. Hofmeyr GJ. Lancet 2016 Feb 2.

Both procedures for cervical ripening had similar effectiveness and safety.

One quarter of pregnant women undergo induction of labor for medical indications (e.g., hypertension, diabetes, fetal growth restriction) or social reasons. An unfavorable cervix (Bishop score <6) can be ripened with oral misoprostol or cervical balloon catheter. Researchers in the Netherlands compared the efficacy and complication rates of these two interventions in a trial involving 1859 women with an unfavorable cervix at ≥37 weeks' gestation. Participants were randomized to oral misoprostol (50 µg every 4 hours; limited to 3 doses daily) or placement of a 30-mL Foley catheter (16 or 18 French).

Fetal outcomes (Apgar score, umbilical cord pH, or rate of a worrisome fetal heart rate tracing during labor) did not differ significantly between groups. More women in the catheter group than in the misoprostol group delivered within 48 hours (80% vs. 75%; P=0.004). The cesarean delivery rate was higher in the catheter group, but the difference did not reach statistical significance. (20% vs. 17%; P=0.067).

Citation(s):

ten Eikelder MLG et al. Induction of labour at term with oral misoprostol versus a Foley catheter (PROBAAT-II): A multicentre randomised controlled non-inferiority trial. Lancet 2016 Feb 2; [e-pub].

Hofmeyr GJ.Oral misoprostol is as safe as Foley catheter for labour Induction … or is it? Lancet 2016 Feb 2; [e-pub]. 

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