Whether Vaginal Misoprostol has Better Outcome than Intra Cervical Catheterization for Cervical Ripening in Intra Uterine Fetal Death
Tashrifa Rahman *
Department of Obstetrics and Gynecology, Kurmitola General Hospital, Dhaka, Bangladesh.
Rajib Hassan Ibn Shafiullah
Department of Urology, Sir Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh.
Barna Das
Department of Obstetrics and Gynecology, Khulna Medical College Hospital, Khulna, Bangladesh.
Razia Sultana
Directorate General of Health Services (DGHS), Dhaka, Bangladesh.
Ferdous Ara
Department of Obstetrics and Gynecology, Rangamati General Hospital, Rangamati, Bangladesh.
Muna Shalima Jahan
Department of Obstetrics and Gynecology, Dhaka Medical College, Dhaka, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Background: Intrauterine fetal death (IUFD) is one of the most distressing obstetric complications, necessitating timely and safe induction of labor to prevent maternal morbidity. Effective cervical ripening is crucial to ensure successful induction and reduce complications. Both vaginal misoprostol and intracervical Foley’s catheterization are widely used for this purpose; however, their relative efficacy and safety in IUFD cases remain under evaluation.
Objective: To compare the efficacy and safety of vaginal misoprostol versus intracervical Foley’s catheterization for cervical ripening in cases of intrauterine fetal death (IUFD) between 28 weeks and full-term gestation.
Methodology: This randomized clinical trial was conducted at the Department of Obstetrics and Gynaecology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, from May 2023 to January 2024. A total of 108 women diagnosed with IUFD were enrolled and randomly assigned into two groups: Group A received vaginal misoprostol (25 µg every 6 hours for 24 hours), and Group B underwent intracervical Foley’s catheterization for 24 hours. Primary outcomes included initiation-to-cervical ripening time and cervical ripening-to-delivery time, while secondary outcomes assessed oxytocin augmentation, duration of augmentation, and complications.
Results: The mean initiation-to-cervical ripening time was significantly shorter in the misoprostol group compared to the Foley’s catheter group (11.53 ± 6.59 hours vs. 16.0 ± 8.99 hours; p = 0.005). However, no significant difference was found in the cervical ripening-to-delivery interval (p = 0.120). The need for oxytocin augmentation was markedly lower in the misoprostol group (40.7%) than in the catheter group (83.3%) (p < 0.001), with a shorter augmentation duration (5.78 ± 2.30 vs. 8.30 ± 4.46 hours; p = 0.014). Both methods were well tolerated, with minimal hyperstimulation and no cases of uterine rupture. Postpartum hemorrhage occurred more frequently in the catheter group (18.5%) than in the misoprostol group (5.6%) (p = 0.038).
Conclusion: Vaginal misoprostol demonstrated greater efficacy in cervical ripening compared to intracervical Foley’s catheterization, achieving faster cervical readiness and requiring less oxytocin augmentation with comparable safety. Hence, vaginal misoprostol (25 µg every 6 hours) may be considered a superior and reliable method for cervical ripening in IUFD cases.
Keywords: Intrauterine fetal death, cervical ripening, vaginal misoprostol, intracervical Foley’s catheter, oxytocin augmentation, labor induction