During the study period, 1210 women underwent labour induction. 538 (42.9%) met the inclusion criteria and were included in our study. The final responsive rate was 96.7%, thus 520 women in total.
The main indications for labour induction were prolonged pregnancy (37,9%) gestational diabetes (26,0%) and maternal pathologies such as gestational cholestasis, diabetes or placental vascular diseases (18,8%). There was a very low rate of induction of labour on-demand at 39 weeks (1,15%).
Maternal characteristics are reported in Table 1. Maternal age, pre-pregnancy BMI, ethnicity, pre-existing and/or pregnancy comorbidity, gestational age at induction and initial Bishop score were comparable between groups. Regarding obstetrical outcomes, there was no difference between the three groups in terms of total duration of labour induction, rate of deliveries within 24 hours after the beginning of labour induction, delivery route or rate of instrumental deliveries.
Table 1
Maternal demographics and baseline characteristics
| FOLEY CATHETER | ORAL MISOPROSTOL | PGE2 PESSARY |
| N = 60 n (11.5%) | N = 351 n (67.5%) | N = 109 n (21%) |
Age (y) | 32 [28.75–35] | 31 [27–35] | 31 [28–35] |
BMI (kg/m2) | 22 [20.75–25] | 25 [20.75–25] | 24[21–28] |
Obesity | 6 (10.0) | 77 (21.9) | 21 (19.3) |
Ethnicity | | | |
Caucasian | 46 (76.7) | 230 (65.5) | 81 (74.3) |
North African | 10 (16.7) | 84 (23.9) | 16 (14.7) |
Subsaharian African | 4 (6.7) | 24(6.8) | 9 (8.2) |
Asia | 0 | 4 (1.1) | 1 (0.9) |
Other | 0 | 9 (2.6) | 2 (1.8) |
Comorbidities | | | |
Chronic hypertension | 0 | 9 (2.6) | 4 (3.7) |
Pre-existing diabetes | 0 | 14(4) | 4(3.7) |
Parity | | | |
Nulliparity | 40 (66.7) | 217 (61.8) | 68 (62.4) |
Pregnancy complications | | | |
Gestational hypertension | 3 (5.0) | 18 (5.1) | 7 (6.4) |
Preeclampsia | 0 | 22 (6.3) | 6 (5.5) |
Gestational diabetes | 15 (25.0) | 114 (32.5) | 25 (22.9) |
GA at labour induction | 39.7 [38.9–41.3] | 39.4 [38.9–41] | 39.4 [38.7–41.3] |
Initial Bishop score | 1 [0–3] | 1 [0–3] | 1 [0–3] |
Duration of labour induction | 36 [27–43.25] | 28 [20.5–37] | 31 [19–39] |
Delivery within 24 hours | 13 (21.7) | 131 (37.3) | 37 (34.3) |
Mode of delivery | | | |
Spontaneous vaginal delivery | 43 (71.7) | 220 (62.7) | 64 (58.7) |
Instrumental delivery | 5 (8.3) | 51 (14.5) | 18 (16.5) |
Caesarean section | 12 (20) | 80 (22.8) | 27 (24.8) |
Data are shown as median [interquartile range] or number (%). |
BMI, body mass index; GA, Gestational Age |
In our population, 67.5% chose oral misoprostol versus 21% and 11,5% respectively for PGE2 pessary and Foley catheter. In the misoprostol group, for 73% of these women, the main argument for their choice was the oral administration compared to the other two options that are vaginal. 18.5% mentioned that taking the medication themselves gave them an active role in their labour induction. 21% of patients chose PGE2 pessary. They justified their choice in 51.4% of cases by the intravaginal administration. 22.9% argumented that they had been advised by their entourage. Finally, 11,5% of patients chose to be induced with a Foley catheter, 80% of which said to be attracted by the non-pharmacological character of this device.
Regarding our main outcome, we found no significant difference between the three groups with global satisfaction, rates being quite similar 78,4%, 68,8% and 71,2% (p = 0,091) for oral misoprostol, PGE2 pessary and Foley catheter respectively (Table 2).
Table 2
Primary and secondary outcomes
| FOLEY CATHETER | ORAL MISOPROSTOL | PGE2 PESSARY | Univariate analysis p value | Multivariate analysis * p value |
| N = 60 n (11.5%) | N = 351 n (67.5%) | N = 109 n (21%) | | |
Primary outcome Global satisfaction | 42 (71.2) | 272 (78.4) | 75 (68.8) | 0.091 | 0.107 |
Secondary outcomes Pain | 16 (27.1) | 120 (34.5) | 57 (52.3) | < 0.001 | < 0.001 |
Satisfaction of pain management | 49 (83.1) | 302 (86.8) | 89 (81.7) | 0.368 | 0.574 |
Perception of duration of induction | 29 (49.2) | 207 (59.3) | 62 (56.9) | 0.334 | 0.408 |
Vaginal exams | | | | 0.787 | 0.634 |
Too much | 1 (1.7) | 14 (4.0) | 4 (36.7) | | |
Adapted | 49 (83.1) | 277 (79.6) | 92 (84.4) | | |
Insufficient | 9 (15.3) | 57 (16.4) | 13 (11.9) | | |
Same method for a future induction | 42 (72.4) | 265 (77.7) | 60 (56.6) | < 0.001 | < 0.001 |
Feeling of respect about their wishes | 57 (96.6) | 336 (97.1) | 107 (98.2) | 0.794 | 0.713 |
Recommended method for relatives | 45 (76.3) | 294 (85.5) | 79 (73.1) | 0.008 | 0.007 |
Satisfaction delivery | 54 (91.5) | 324 (93.6) | 101 (92.7) | 0.686 | 0.833 |
Data are n (%) unless otherwise specified. |
*multivariate analysis adjusted on history of labour induction. indication of labour induction. parity and obesity. |
The global satisfaction of labour induction was 72,8%, compared to 36% in the period without offering women the choice of the cervical ripening method (p < 0.001).
93.4% of the patients reported that the information they received about the several methods of labour induction was sufficient. 95,2% of the patients were satisfied with their final choice and only 3,65% of the women mentioned that having the choice increased their anxiety.
52,3% of the patients in the PGE2 pessary group mentioned that labour induction method was more painful than expected, vs 27.1% and 34.5% in the Foley catheter group and in the misoprostol group respectively (p < 0,001). We found a significant difference in what method women would choose for a future labour induction: 56,7% of patients in the PGE2 pessary group would make the same choice compared to 77,7% and 72,4% in the misoprostol and the Foley catheter group (p < 0,001). There was no significant difference in global satisfaction concerning delivery between the chosen method of induction. 97% of the patients felt their choices had been respected during labour induction without significant difference between the three groups.
Finally, we identified that nulliparity (OR = 2.03, 95%CI [1.19–3.53]), delivery within 24 hours after the start of induction (OR = 3.46, 95%CI. [2.02–6.14]) and adequate information (OR = 4.21,95%CI [1.86–9.64]) were significantly associated with greater satisfaction (Table 3).
Table 3
Variables associated with satisfaction
| OR | 95% CI |
Method of labour induction | | |
Foley catheter | ref | |
Oral misoprostol | 1.32 | [0.66–2.56] |
PGE2 pessary | 0.78 | [0.36–1.64] |
Indication of labour induction | | |
Term | ref | |
Maternal pathology | 1.04 | [0.58–1.92] |
Gestational diabetes or macrosomia | 2.17 | [1.20–4.02] |
On-demand | 1.16 | [1.00–1.35] |
Placental pathology | 0.98 | [0.52–1.89] |
Nulliparity | 2.03 | [1.19–3.53] |
Adequate information | 4.21 | [1.86–9.64] |
Instrumental delivery | 1.08 | [0.53–2.32] |
Caesarean section | 0.31 | [0.17–0.54] |
Delivery within 24 hours | 3.46 | [2.02–6.14] |
Postpartum hemorrhage | 0.51 | [0.30–0.88] |
OR, Odds ratio ; CI, Confidence interval |
Factors associated with lower satisfaction were the occurrence of postpartum hemorrhage (OR = 0.51, 95%CI [0.30–0.88]) and caesarean section (OR = 0.31, 95%CI [0.17–0.54]).