Archives of Gynecology and Obstetrics

, Volume 299, Issue 2, pp 451–457 | Cite as

Transcervical Foley balloon catheter and vaginal prostaglandin E2 insert combination vs. vaginal prostaglandin E2 insert only for induction of labor at term: a randomized clinical trial

  • Ahmet Eser
  • Enis Ozkaya
  • Cigdem Yayla AbideEmail author
  • Tugba Eser
  • Gulcin Yildirim Eser
  • Faruk Abike
  • Ahter Tanay Tayyar
  • Mustafa Eroglu
Maternal-Fetal Medicine



To analyze the effect of combined application of intravaginal PGE2 insert and intracervical Foley balloon catheter for induction of labor.


Patients with unfavorable cervices who required induction of labor from August 2017 to December 2017 were evaluated for the study. Three hundred and ten participants were randomly assigned to study (n:155) and control group (n:155). Nine patients in study group and seven patients in control group were excluded, because they declined to participate in the study. Totally, 294 women analyzed in this prospective randomized study: Group 1 (control group): labor induction with intravaginal PgE2 vaginal insert alone (n = 148) and Group 2 (study group): intracervical Foley balloon catheter insertion adjunct to the intravaginal PgE2 insert (n = 146). The primary outcome of our study was the period from induction to delivery. The secondary outcome was the period from induction to active phase of labor.


In the analysis of primiparous pregnants, combination of intracervical Foley balloon catheter and intravaginal PgE2 insertion was shown to be associated with shorter duration from induction to active stage of labor (1000 vs. 585 min, P < 0.001) and also to delivery (1386 vs. 1001 min, P < 0.001). Groups were found to be similar in terms of duration from induction to active stage of labor (670.5 vs. 535.2, P > 0.05) and also to delivery (933.1 vs. 777.9, P > 0.05, Table 2) in subgroup of women with the previous vaginal delivery.


Combined application of intracervical Foley balloon catheter and intravaginal PgE2 insert may result in a shorter time from labor induction to delivery without rising the risk of cesarean section in primiparous women with an unfavorable cervix.


Dinoprostone Intracervical Foley catheter Labor induction Unfavorable cervix Prostaglandin insert 


Author contributions

EA: conception and design of the study and acquisition of data. OE: data analysis and manuscript writing and editing. YAC: methodology, acquisition of data, and manuscript editing. ET: data analysis and methodology. YEG: design of the study and manuscript writing. AF: data analysis and supervision. TTA: acquisition of data. EM: acquisition of data and supervision.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    ACOG Committee on Practice Bulletins—Obstetrics (2009) ACOG practice bulletin no. 107: induction of labor. Obstet Gynecol 114:386CrossRefGoogle Scholar
  2. 2.
    Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M (2012) Mechanical methods for induction of labor. Cochrane Database Syst Rev 3:CD001233Google Scholar
  3. 3.
    Chen W, Xue J, Peprah MK et al (2016) A systematic review and network meta-analysis comparing the use of Foley bulbs, misoprostol, and dinoprostone for cervical ripening in the induction of labor. BJOG 123(3):346–354CrossRefGoogle Scholar
  4. 4.
    Carbone JF, Tuuli MG, Fogertey PJ, Roehl KA, Macones GA (2013) Combination of Foley bulb and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and labor induction: a randomized controlled trial. Obstet Gynecol 121:247–252CrossRefGoogle Scholar
  5. 5.
    Delaney S, Shaffer BL, Cheng YW, Vargas J, Sparks TN, Paul K, Caughey AB (2010) Labor induction with a Foley balloon inflated to 30 mL compared with 60 mL: a randomized controlled trial. Obstet Gynecol 115(6):1239–1245CrossRefGoogle Scholar
  6. 6.
    Calder AA, Loughney AD, Weir CJ, Barber JW (2008) Induction of labor in nulliparous and multiparous women: a UK, multicentre, open-label study of intravaginal misoprostol in comparison with dinoprostone. BJOG 115(10):1279–1288CrossRefGoogle Scholar
  7. 7.
    Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR (2012) Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 120(5):1181–1193Google Scholar
  8. 8.
    Al-Ibraheemi Z, Brustman L, Bimson BE, Porat N, Rosenn B (2018) Misoprostol with Foley bulb compared with misoprostol alone for cervical ripening: a randomized controlled trial. Obstet Gynecol 131(1):23–29Google Scholar
  9. 9.
    Ugwu EO, Onah HE, Obi SN, Dim CC, Okezie OA, Chigbu CO, Okoro OS (2013) Effect of the Foley catheter and synchronous low dose misoprostol administration on cervical ripening: a randomised controlled trial. J Obstet Gynaecol 33(6):572–577CrossRefGoogle Scholar
  10. 10.
    Hill JB, Thigpen BD, Bofill JA, Magann E, Moore LE, Martin JN Jr (2009) A randomized clinical trial comparing vaginal misoprostol versus cervical Foley plus oral misoprostol for cervical ripening and labor induction. Am J Perinatol 26(1):33–38CrossRefGoogle Scholar
  11. 11.
    Kehl S, Ehard A, Berlit S, Spaich S, Sütterlin M, Siemer J (2011) Combination of misoprostol and mechanical dilation for induction of labour: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 159(2):315–319CrossRefGoogle Scholar
  12. 12.
    Rust OA, Greybush M, Atlas RO, Jones KJ, Balducci J (2001) Preinduction cervical ripening. A randomized trial of intravaginal misoprostol alone vs. a combination of transcervical Foley balloon and intravaginal misoprostol. J Reprod Med 46(10):899–904Google Scholar
  13. 13.
    Chung JH, Huang WH, Rumney PJ, Garite TJ, Nageotte MP (2003) A prospective randomized controlled trial that compared misoprostol, Foley catheter, and combination misoprostol–Foley catheter for labor induction. Am J Obstet Gynecol 189:1031–1035CrossRefGoogle Scholar
  14. 14.
    Levine LD, Downes KL, Elovitz MA, Parry S, Sammel MD, Srinivas SK (2016) Mechanical and pharmacologic methods of labor induction: a randomized controlled trial. Obstet Gynecol 128:1357–1364CrossRefGoogle Scholar
  15. 15.
    Vahratian A, Zhang J, Troendle JF, Sciscione AC, Hoffman MK (2005) Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstet Gynecol 105(4):698–704CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyZeynep Kamil Women and Children’s Health Training and Research HospitalIstanbulTurkey
  2. 2.Department of Obstetrics and GynecologyKocaeli UniversityKocaeliTurkey
  3. 3.Department of Obstetrics and GynecologySancaktepe Education and Research HospitalIstanbulTurkey
  4. 4.Department of Obstetrics and GynecologyBilim UniversityIstanbulTurkey

Personalised recommendations