Comparative study of foley’s catheter and misoprostol versus mifepristone and misoprostol in induction of midtrimester abortions: a retrospective study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20243702Keywords:
Foley catheter, Mifepristone, Misoprostol, Pregnancy terminationAbstract
Background: To compare the efficacy and safety of intracervical Foley’s catheter and misoprostol versus mifepristone and misoprostol induction of midtrimester abortions.
Methods: I conducted a retrospective comparative study at a university affliated tertiary hospital at the postpartum unit of the department of obstetrics and gynaecology, Government Medical College, Amritsar from January 2022 to December 2023. Records were available for 80 patients who underwent midtrimester abortion. The enrolled women were allocated in two groups. Group A comprised women who underwent induction with combined intracervical Foley’s catheter and misoprostol (n=42). Group B included women who underwent midtrimester abortion with mifepristone and misoprostol (n=38). The procedure efficacy and safety of the procedure were assessed.
Results: There was complete foetal expulsion in all cases in Group A (100%) while the success rate was 89.47%in Group B. The induction to abortion (IAI) interval was significantly shorter in Group A than Group B (6.66±1.1 versus 9.42±2.69hours, p=.000). Group A had shorter insertion to balloon expulsion time (7.80±0.87). The women with nulliparity, longer interpregnancy interval (>22 months), smaller gestational age (just 14 weeks) and lower Bishop Score before insertion (<2) had poorer outcome.
Conclusions: The present results confirmed that a combined mechanical and pharmacological approach for midtrimester abortions has comparable efficacy and safety to induction with vaginal mifepristone and misoprostol and can be safely recommended. Further, it reduces the total dosage of misoprostol required for termination and shortens the termination interval, thereby increasing the patient comfort and is more affordable.
Metrics
References
Romero Nalini SH, Ahanthem SS. Different time schedules of mifepristone and misoprostol in second trimester medical abortion: A comparative study. J Midwif Reprod Health. 2017;5(3):930-4.
Second trimester medical abortion with mifepristone-misoprostol and misoprostol alone: a review of methods and management. Reprod Health Matters. 2008:16 (31):162-72.
Ercan O, Kostu B, Ozer A, Serin S, Bakacak M. Misoprostol versus misoprostol and foley catheter combination in 2nd trimester pregnancy. J Matern Fetal Neonatal Med. 2016;29(17):2810-2.
Elasy AN, Ibrahem MM, Elhawy LL, Hamed BM. Vaginal misoprostol versus combined intracervical foley’s catheter and oxytocin infusion for second trimester pregnancy termination in women with previous caesarean sections: a randomised control trial. J Obstet Gynaecol. 2022;42(7):2962-9.
Velipasaoglu M, Ozdemir CY, Ozek B, Ayaz R, Tanir HM. Sequential use of Foley catheter with misoprostol for second trimester pregnancy termination in women with and without caesarean scars:a prospective cohort study. J Matern Fetal Neonatal Med. 2018;31(5):677-81.
Hackett GA, Reginald P, Paintin DB. Comparison of the Foley catheter and dinoprostone pessary for cervical preparation before second trimester abortion. Br J Obstet Gynaecol. 1989;96(12):1432-4.
Ali MK, Botros HA, Mostafa SA. Foley’s catheter balloon for induction of mid-trimester missed abortion with or without traction applied: a randomized controlled trial. J Matern Fetal Neonatal Med. 2020;33(2):198-205.
Fathalla MM, Maghraby AM, Tarek K, Hussaini AL, Alaa MI. Different methods of termination of second trimester pregnancy at Women’s Health Hospital, Assiut University: efficacy and complications.Int J Reprod Contracept Obstet Gynaecol. 2017;6(8):3241-6.
Rezk MA, Sanad Z, Dawood R, Emarh M, Masood A. Comparison of intravaginal misoprostol and intracervical Foley catheter alone or in combination for termination of second trimester pregnancy. J Matern Fetal Neonatal Med. 2015;28(1):93-6.
Veena L, Sarojini. A review of medical termination of pregnancy profile in a tertiary care center. Int J Reprod Contracep Obst Gyn. 2017;6(8):3332-7.
BalaSubramanian SR, Ayyar P. A comparative study combination of mifepristone and misoprostol or misoprostol alone in second trimester abortion. Int J Sci Res. 2017;6(5):27-9.
Holla R, Kanchan T, Unnikrishnan B, Kotian MS, Kumar N, Thapar Retal. Profile of women seeking medical termination of pregnancy in South india. Int J Gynaecol Obstet. 2014;125(3):253-5.
Patel U, Chauhan K, Singhi S, Kanani M. Second trimester abortion-mifepristone and misoprostol or misoprostol alone? Int J Reprod Contracept Obstet Gynaecol. 2013;2(3):315-9.
Goh SE, Thong KJ. Induction of second trimester abortion (12-20 weeks) with mifepristone and misoprostol: a review of 386 consecutive case. Contraception. 2006;73(5):516-9.
Kunwar S, Saha PK, GoelP, Huria A, Tandon R. Second trimester pregnancy termination with 400mcg vaginal misoprostol: efficacy and safety. Biosci Trends. 2010;4:351-4.
Hamoda H, Ashok PW, Hett GM, Templeton A. A randomized trial of mifepristone in combination with misoprostol administered sublingually or vaginally foe medical abortion at 13-20 weeks gestation. Hum Reprod. 2005;20(8):2348-54.
Sahu PC, Inamdar IF, Salve D. Abortion among married women of reproductive age group: A community based study. Int J Pharmaceu Sci. 2014;3(9):22-28.
Family Welfare Statistics in India,2011, Statistic Division, Ministry of Health and Family Welfare Government of India. Available at http://www.khubmarriage. Accessed on 7 July 2024.
Cloquer E, Coulon C, Vaast P, Chauvet A, Deruelle P, Subtil D, et al. Use of misoprostol for induction of labour in case of fetal death or termination of pregnancy during second or third trimester of pregnancy: Efficiency, dosage, route of administration, side effects, use in case of uterine scar. J Gynaecol Obstet Biol Reprod (Paris). 2014;43(2):146-61.
Demirezen G, Aslan Cetin B, Aydogan Mathyk B, Koroglu N, Yildirim G. Efficiency of the Foley catheter versus the double balloon catheter during the induction of second trimester pregnancy terminations: a randomized controlled trial. Arch Gynecol Obstet. 2018;298(5):881-7.
Kucukgoz Gulec U, Urunsak IF, Eser E, Guzel AB, Ozgunen FT, Evruke IC, et al. Misoprostol for midtrimester termination of pregnancy in women with 1 or more cesarean deliveries. Int J Gynaecol Obstet. 2013;120(1):85-7.