Whether Vaginal Misoprostol has Better Outcome than Intra Cervical Catheterization for Cervical Ripening in Intra Uterine Fetal Death

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.