A Prospective Case–Control Study of Efficacy and Safety of a Combination of Dinoprostone Gel and Intracervical Foley\'s Catheter vs Dinoprostone Gel Alone for Cervical Ripening

Objective: To compare the efficacy and safety of a combination of an intracervical Foley's catheter with dinoprostone gel vs dinoprostone gel alone for cervical ripening.Study design: Eighty term pregnant women with an indication for induction of labor and an unfavorable cervix (Bishop score 6) were enrolled and assigned into two groups of 40 each. Group A: Received an intracervical Foley's catheter along with 0.5 mg dinoprostone gel placed in the posterior fornix, repeated every 6 hours for a maximum of three doses. Group B: Received 0.5 mg of dinoprostone gel alone, placed in the posterior fornix at the same interval and dose schedule.Both groups were compared for efficacy and safety outcomes.Results: Baseline characteristics, including mean age, parity, and precervical ripening Bishop's score, were similar between both the groups.The mean precervical ripening Bishop score was 2.68 0.62 in group A and 2.98 0.89 in group B. After cervical ripening, the mean Bishop score increased to 5.58 1.04 in group A and 4.94 1.12 in group B, showing a significantly greater improvement in group A (p = 0.0098).A significantly higher proportion of women in group A achieved favorable cervical ripening, had a greater rate of vaginal deliveries (p = 0.044), and experienced shorter cervical ripening interval (p-value = 0.035) and induction-to-delivery interval (p = 0.021) as compared to group B. Complications such as fetal distress, chorioamnionitis, and uterine tachysystole were more frequent in group B. Conclusion:The combination of an intracervical Foley catheter with dinoprostone gel proved to be a more effective and safer method for cervical ripening than dinoprostone gel alone.This combined approach resulted in faster cervical ripening, shorter induction-to-delivery intervals, and fewer complications, suggesting a synergistic benefit of mechanical and pharmacologic methods.