Comparative Study between Oral Misoprostol Alone versus Weighted Intrauterine Foley’s Catheter Plus Oral Misoprostol in Termination of Mid-Trimester Abortion

Background: Second-trimester termination of pregnancy (13-28 weeks of gestation) remains a medical challenge, as it accounts for 10-15% of all induced abortions. In recent years, medical induction has replaced surgical methods; however, this issue continues to be a matter of debate. Aim of the work: This study aimed to investigate the value of inserting a weighted, fluid-filled intrauterine Foley catheter on the outcomes of termination of pregnancy induced by oral misoprostol. Subjects and methods: This study included 50 women indicated for second-trimester termination at the Obstetrics and Gynecology Department of Al-Azhar University Hospital. Women were randomized into one of two groups (each consisting of 25 women). The first group received oral misoprostol (200 micrograms, six times a day). The second group received the same dose of oral misoprostol as the first group, in addition to the placement of a Foley catheter with fixed weight traction at the distal end. Clinical, radiological, and laboratory evaluations were performed. Cervical dilatation and effacement, hemodynamics, and expulsion of the fetus were assessed every four hours and continued for 12 hours post-expulsion. Any complications were recorded. Results: There was no significant difference between the groups regarding demographic or clinical data. Additionally, no significant difference was observed in the need for surgical removal of the placenta (12% vs. 4%), post-expulsion bleeding (12% vs. 4%), or blood transfusion requirements (4% vs. 0%). However, the time from induction to expulsion of the fetus was significantly reduced in the Foley catheter group (Group II) compared to the misoprostol alone group (19.36 ± 4.72 hours vs. 36.32 ± 13.35 hours, respectively). Conclusion: The use of a weighted trans-cervical Foley catheter filled with 30-50 mL of saline improves the effectiveness of 200 µg oral misoprostol in terminating mid-trimester pregnancies.