Misoprostol alone versus misoprostol with foley catheter for termination of second trimester pregnancy: A Systematic Review and Meta-analysis.
Ellen Silva Rodrigues, Ana Carolina Mendes Dominguez, Julia Terra Molisani et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis compared misoprostol alone with misoprostol plus an intracervical Foley catheter for second-trimester pregnancy termination, including randomised trials and retrospective cohorts. Five studies included 657 patients. Adding a Foley catheter did not significantly shorten the induction-to-abortion interval (mean difference -1.29 h; 95% CI -5.92, 3.33; p = 0.58), and no significant differences were found in the reported complications. The combination group used fewer misoprostol doses (mean difference -1.95 doses; 95% CI -3.18, -0.72; p = 0.0019).
Key findings
- The combination did not significantly reduce the induction-to-abortion interval: MD -1.29 h; 95% CI -5.92, 3.33; p = 0.58; I²=85%.
- Misoprostol plus Foley catheter was associated with fewer misoprostol doses: MD -1.95 doses; 95% CI -3.18, -0.72; p = 0.0019; I²=98%.
- No significant differences were observed in incomplete abortion requiring surgery, uterine rupture, hemorrhage, or fever.
Why it matters
The findings suggest that adding a Foley catheter may reduce the number of misoprostol doses without demonstrably shortening the induction-to-abortion interval. The complication comparisons also showed no significant differences, but the evidence does not establish equivalence or rule out clinically important differences, particularly given the small number of included studies and substantial heterogeneity for some outcomes.
What to keep in mind
Only five studies were included, combining randomised trials and retrospective cohorts. Heterogeneity was high for the induction-to-abortion interval and misoprostol dose outcomes.