Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/92832
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Type: Journal article
Title: Induction of labour with a Foley catheter or oral misoprostol at term: The PROBAAT-II study, a multicentre randomised controlled trial
Author: Ten Eikelder, M.
Neervoort, F.
Oude Rengerink, K.
Jozwiak, M.
de Leeuw, J.
de Graaf, I.
van Pampus, M.
Franssen, M.
Oudijk, M.
van der Salm, P.
Woiski, M.
Pernet, P.
Feitsma, A.
van Vliet, H.
Porath, M.
Roumen, F.
van Beek, E.
Versendaal, H.
Heres, M.
Mol, B.
et al.
Citation: BMC Pregnancy and Childbirth, 2013; 13(67):1-6
Publisher: BioMed Central
Issue Date: 2013
ISSN: 1471-2393
1471-2393
Statement of
Responsibility: 
Mieke LG ten Eikelder, Femke Neervoort, Katrien Oude Rengerink, Marta Jozwiak, Jan-Willem de Leeuw, Irene de Graaf, Maria G van Pampus, Maureen Franssen, Martijn Oudijk, Paulien van der Salm, Mallory Woiski, Paula JM Pernet, A Hanneke Feitsma, Huib van Vliet, Martina Porath, Frans Roumen, Erik van Beek, Hans Versendaal, Marion Heres, Ben Willem J Mol, and Kitty W M Bloemenkamp
Abstract: BACKGROUND Induction of labour is a common obstetric procedure. At present, different methods are used for induction of labour in women with an unfavourable cervix. Recently, we showed that in term women with an unfavorable cervix the use of a Foley catheter in comparison with vaginal Prostaglandin E2 gel, results in a comparable vaginal delivery rate. A meta-analysis on the subject indicated lower rates of hyperstimulation, and probably as a sequel fewer cases of postpartum haemorrhage. Misoprostol (PgE1) is another type of prostaglandin frequently used for labour induction, recommended by the international federation of gynaecology and obstetrics (FIGO). Misoprostol can be administered by vaginal, rectal and oral route. There is evidence that oral administration results in less asphyxia and hyperstimulation than vaginal administration. At present, valid comparisons between oral misoprostol and Foley catheter are lacking. Therefore, we propose a randomised controlled trial comparing Foley catheter to oral misoprostol in order to assess safety and cost-effectiveness. METHODS/DESIGN We plan a multicentre, randomised, controlled, open-label clinical trial among term pregnant women with a vital singleton in cephalic presentation, unfavorable cervix, intact membranes and an indication for induction of labour. After informed consent, women will be randomly allocated by a webbased randomisation system to transcervical Foley catheter or oral misoprostol (50 mcg every 4 hours). The primary outcome will be a composite of complications of uterine hyperstimulation, i.e. post partum haemorrhage and asphyxia. Secondary outcomes are mode of delivery, maternal and neonatal morbidity, costs and women’s preference. Serious adverse events such as severe maternal or neonatal morbitity or mortality will be monitored and reported to an independent data safety monitory board. With a sample size of 1860 women we will be able to demonstrate a 5% non-inferiority of the Foley catheter as compared to misoprostol for the composite outcome. DISCUSSION Worldwide, various methods are being used for labour induction. Results of the proposed trial will contribute to the answer which method of induction of labour is most safe, cost-effective, and patient friendly and will help to construct evidence based guidelines. TRIAL REGISTRATION The Netherlands Trial Register NTR3466
Keywords: Induction of labour; Oral misoprostol; Foley catheter; Asphyxia; Post partum haemorrhage; Hyperstimulation; Bishop score; Unfavourable cervix
Rights: © 2013 ten Eikelder et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: 10.1186/1471-2393-13-67
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