Sequential Versus Concurrent Use of Vaginal Misoprostol Plus Foley Catheter for Induction of Labor: A Randomized Clinical Trial

  • Ibrahim Abd Elgafor El Sharkwy
  • Elsayed Hamdy Noureldin
  • Ekramy Abd Elmoneim Mohamed
  • Sherine Attia Shazly
Original Article



To compare between the sequential and concurrent use of vaginal misoprostol plus Foley catheter for labor induction.


This single-center, non-blinded randomized study was conducted at the department of Obstetrics and Gynecology, Faculty of medicine, Zagazig University. A total of 160 women with full term singleton pregnancy, cephalic presentation and bishop score ≤ 6 were randomized for labor induction with either concurrent or sequential use of vaginal misoprostol plus Foley catheter (80 cases in each group). The primary outcome measured was induction-to-delivery interval and secondary outcomes mesaured were vaginal delivery within 24 h, number of doses needed to induce labor, need of oxytocin for augmentation of labor, cesarean section rate, maternal or neonatal complications.


The mean induction-to-delivery interval was 22.33 ± 13.28 h versus 18.45 ± 14.34 h (p = 0.041) in sequential and concurrent group, respectively. The percentage of women who completed vaginal delivery within 24 h was 51% versus 61% (p = 0.046) in sequential and concurrent group, respectively. Other maternal and neonatal outcomes were similar in both groups


Concurrent use of vaginal misoprostol plus Foley catheter for labor induction was associated with shorter induction-to delivery interval compared to sequential use, and it increases the rate of vaginal delivery in the first 24 h.


Concurrent Foley catheter Induction Labor Misoprostol Sequential Vaginal 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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

Informed Consent

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


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Copyright information

© Federation of Obstetric & Gynecological Societies of India 2017

Authors and Affiliations

  • Ibrahim Abd Elgafor El Sharkwy
    • 1
  • Elsayed Hamdy Noureldin
    • 1
  • Ekramy Abd Elmoneim Mohamed
    • 1
  • Sherine Attia Shazly
    • 1
  1. 1.Faculty of MedicineZagazig UniversityZagazigEgypt

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