Comparative Efficacy and Safety of Titrated Misoprostol Solution with Intracervical Foley Catheter and Misoprostol Tablets for Cervical Ripening and Induction of Labour at Term: A Randomized Controlled Trial

Abstract

Introduction: When the cervix is not favourable, induction of labour at term is often performed with the aid of cervical ripening. The efficacy, induction time, and safety profile of the two methods are different.

Objective: To evaluate the effectiveness and safety of titrated misoprostol solution with intracervical Foley catheter, and misoprostol tablets for cervical ripening and induction of labour at term.

Materials and Methods: This was a randomized controlled trial in the Department of Obs & Gynecology, Saidu Group of Teaching Hospitals Saidu Sharif l from 1st February to 31st July 2026. A total of 100 eligible women were randomly allocated equally to two groups: the first group was given titrated misoprostol solution with intracervical Foley catheter, and the second group was given misoprostol tablets. Maternal, labour, and neonatal outcomes were evaluated.

Results: There was a shorter induction-to-delivery interval and greater improvement in Bishop score with the use of titrated misoprostol solution with intracervical Foley catheter, with a lesser need for augmentation with oxytocin. There were no differences in the rates of vaginal or caesarean delivery. The incidence of uterine tachysystole was higher with misoprostol tablets, while the neonatal outcomes were comparable.

Conclusions: The use of titrated misoprostol solution with intracervical Foley catheter seemed to offer a good balance of rapid cervical ripening, shorter induction time, and maternal and neonatal safety.