A Randomised Controlled Trial Comparing Transcervical foleys catheter with vaginal misoprostol vs Vaginal misoprostol alone in Nulliparous Pregnant women at 40 weeks.

Induction of labor (IOL) implies stimulation of uterine contractions before the spontaneous onset of labor, with or without ruptured membranes.It is an intervention designed for iatrogenic ripening of cervix and to initiate uterine contractions leading to progressive dilatation and effacement of cervix resulting into birth of the newborn. It is indicated only when the risks of continuing pregnancy outweigh the benefits to the mother and the fetus. The goal of IOL is to achieve vaginal delivery in a safe and timely manner. Methods of IOL presently in use include various mechanical, pharmacological or a combination of mechanical and pharmacological.  Mechanical methods include use of various agents such as transcervical foley’s catheter (TCFC), laminaria tents, synthetic osmotic dilators etc. TCFC is a cheap, readily available, easy to use and moreover a comparatively painless alternative which affects changes on various components of the bishop score.. TCFC works through mechanical dilation, resulting in the release of natural prostaglandins from the cervix.Pharmacological methods of IOL include agents such as oxytocin, prostaglandins (e.g. Misoprostol i.e. PGE1 and Dinoprostone i.e. PGE2), mifepristone etc.Prostaglandins ripen the cervix directly by enzymatic collagen degradation and increase of water content in the extracellular matrix. It effectively ripens the cervix and also induces uterine contractions. Its use can result in shorter induction-to-delivery times. The catheters have several potential advantages over pharmacologic methods. They are relatively inexpensive, easy to store, and easy to remove when necessary lacks systemic side effects, reversible and can be used in women with previous CS.

Hence, we plan to compare vaginal misoprostol alone vs TCFC with vaginal misoprostol as an adjunct for IOL in pregnant women at term.