BRIEF COMMUNICATION Cervical ripening and induction of labor with intravaginal misoprostol and Foley catheter cervical traction M. Kashanian a, * , A.R. Akbarian b , M. Fekrat a a Department of Obstetrics and Gynecology, University of Medical Sciences and Health Services, Akbar Abadi Teaching Hospital, Tehran, Iran b Department of Obstetrics and Gynecology, Iran University of Medical Sciences and Health Services, Hazrat Rasool Hospital, Tehran, Iran Received 21 August 2005; received in revised form 5 September 2005; accepted 7 September 2005 A randomized controlled trial was performed to study 300 pregnant women with an indication for termination of pregnancy. Inclusion criteria were gestational age of 28 weeks or greater, Bishop score of 5 or less, singleton pregnancy, cephalic presen- tation, and intact membranes. Exclusion criteria were previous cesarean delivery or any surgical operation on the uterus, vaginal bleeding, known allergy to prostaglandins, and intrauterine growth restriction or fetal distress. The 300 women were randomly assigned to 3 groups. In 100 women, 25 Ag of misoprostol (Cytotec; Upjohn, USA) was administered intravaginally and administration was repeated every 3 h for a maximum 6 doses or 150 Ag of misoprostol. In the second group of 100 women, one end of a No. 16 Foley catheter was introduced through the cervical canal and fixed, and the other end was connected to a bag hung on the bed and containing 500 mL of serum to produce traction on the cervix. In the third group of 100 women (the combina- tion group), after the Foley catheter was inserted and traction produced, misoprostol was adminis- tered intravaginally as in the first group. In the absence of uterine contractions after 12 h, oxytocin was infused for termination of pregnancy in the 3 groups. Oxytocin administration was started at the dose of 2 mU/min and augmented every 15 min with 2 mU/min increments until good contractions were obtained. The maximum dose of oxytocin was 40 mU/min, and induction with oxytocin was continued for a maximum of 12 h. In cases of no 0020-7292/$ - see front matter D 2005 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. doi:10.1016/j.ijgo.2005.09.010 * Corresponding author. khajeh Nasir Toosi Ave, Mostaghimi alley, No, 83, Tehran, Iran. 16117. Tel.: +98 21 77523487; fax: +98 21 77607016. E-mail address: maryamkashanian@yahoo.com (M. Kashanian). International Journal of Gynecology and Obstetrics (2006) 92, 79—80 KEYWORDS Misoprostol; Foley catheter; Labor induction; Cervical ripening; Traction on the cervix www.elsevier.com/locate/ijgo