Background: Success of induction depends on the cervical favorability, which is quantified in points by Modified Bishop Score. Aim: This study compared the efficacy and safety of Extraamniotic Saline Instillation with Transcervical Foley Catheter and Vaginal PGE2 for improving Bishop score in term pregnant patients. Materials and  Methods: It is a prospective and comparative study on 200 patients with various indications for induction with unfavorable cervix (Bishop score <6), satisfying inclusion and exclusion criteria, are the subjects of the study. All patients undergone vaginal examination, the patients were divided randomly into two groups. Group A: 100 Cases, in whom, PGE2 gel was instilled intracervically for preinduction cervical ripening. Group B: 100 Cases, in whom, extramniotic saline infusion was done along with transcervical Foley catheter. Results: The mean Bishop Score at Zero hour of both the groups was comparable 3.92±1.49 in Group A and 3.5±1.48 in Group B. Success of cervical ripening defined as improvement in Bishop score > 4 points at the end of 24hours. Cervical ripening failure
was defined as a increase in Bishop’s score < 4 points following 24 hours. There were 78% with successful ripening in Group A and 94% in Group B. The difference in the success rates among the two groups is significant (p<0.05). 25% in Group A and 37% in Group B had an instillation delivery interval between 24 & 48 hours. There is no significant difference in instillation delivery interval among the two groups. 83% in Group B and 58% in Group A had vaginal delivery. 43% in Group A and 16% in Group B had EMLSCS. Uterine tachysystole was seen 4% patients in Group A and no patient in Group B had tachysystole. There was no significant
difference in the APGAR at 1min and 5mins in both the groups. 18% in Group A and 16% in Group B had NICU admissions. The indications for admissions were APGAR at 5min <7, Meconium stained liquor and respiratory distress.

Conclusions: Extraamniotic saline Instillation with Transcervical Foley Catheter is better alternative to PGE2 in term higher success rate in improvement in Bishop score, shorter ripening time, fewer complications like uterine tachysystole. 

Keywords: PGE2; Extraamniotic Saline Infusion; Transcervical Foleys Catheter; Cervical Ripening.