Foley's Catheter with Amniotomy Investigated for Faster Mid-Trimester Abortion Induction in Nulliparous Women

Second-trimester abortion accounts for 10-15% of all induced abortions globally and is associated with two-thirds of all serious abortion-related complications. While combined mifepristone and misoprostol regimens achieve high success rates (97-99% within 24 hours), mifepristone is often unavailable or unaffordable in many regions, leaving misoprostol alone as a less effective option with higher side effects. For nulliparous women with an unfavorable cervix, an optimal induction method remains undefined. Foley's catheter is recognized for its role in cervical ripening and improving Bishop's score, potentially by mechanical dilation and inducing localized inflammation that increases prostaglandin and/or oxytocin release. This study aims to investigate whether the addition of amniotomy can further enhance this process.

This randomized, controlled study enrolled 60 nulliparous women requiring mid-trimester abortion due to conditions such as missed abortion or serious fetal abnormalities. Participants were randomized into two arms: an Amniotomy group where amniotomy was performed using toothed forceps after the insertion of an intra-cervical Foley's catheter balloon, and a No-amniotomy group receiving the Foley's catheter alone. The primary endpoint measured was the interval between induction to complete abortion. The study design aimed to determine if the mechanical disruption of amniotomy, in conjunction with Foley's catheter, could reduce the time to expulsion of the fetus compared to Foley's catheter alone, addressing a gap in literature regarding amniotomy's role in second-trimester abortion.