Please select the eligibility criteria that correspond to the clinical trial below.
Title: Foley OR MisO for the Management of Induction (FOR MOMI) Trial
Brief Summary: The percentage of women undergoing an induction of labor (IOL) is estimated to be 20% and continues to rise. Simultaneously, the cesarean delivery (CD) rate has continued to increase (2). Induction is a known risk factor for CD. Despite numerous studies evaluating time periods to define a failed IOL, there are no guidelines or accepted definitions of when to call an IOL failed given the incremental gain in vaginal delivery when IOL is prolonged. While decreasing the CD rate is an important primary focus in obstetrics, attention must also be paid to the overall length of labor given that prolonged labor is associated with adverse maternal and neonatal outcomes. Furthermore, a prolonged labor is associated with an increase in direct hospital costs and healthcare utilization. The use of cervical ripening agents, such as vaginal prostaglandin and mechanical dilators, has been demonstrated to reduce labor time and CD rate. In addition to specific individual agents, certain dosing and regimens for IOL and active labor have been compared to evaluate whether a particular dose or regimen can decrease the length of labor and decrease the CD rate. Most of these regimens; however, focus on individual induction agents and few have compared the efficacy of using more than one agent simultaneously. Given the associated risks of prolonged labor and limited data evaluating the use of combined cervical ripening agents, our objective is to evaluate the difference in time to delivery among women who undergo an IOL with four different methods.


Options:
A: Inclusion Criteria:

* Age greater than 18 years
* Pregnant, singleton gestation, vertex presentation
* Admitted for induction of labor between gestational ages 24 - 42 weeks
* Bishop score \<6

Exclusion Criteria:

* Multiple gestation
* Non-vertex presentation
* Latex allergy or latex-free Foley catheter to be placed
* Fetal death
* Anomalous fetus
* Placenta/vasa previa
* Placental abruption (known or suspected)
* Intrapartum bleeding
* Non-reassuring fetal tracing with following criteria: category III tracing, OR minimal variability AND decelerations of any kind, OR late decelerations occurring \>50% of contractions
* 2 or more previous cesarean section, myomectomy, or classical cesarean
* Need to use ripening agents prior to Foley placement
* Spontaneous labor
* Active genital herpes
* Inability to consent
* Any contraindication to a vaginal delivery
B: Inclusion Criteria:

* Single viable intrauterine pregnancy
* Cephalic presentation
* Bishop score \<6
* Need for induction of labor

Exclusion Criteria:

* Multiple gestation
* Bishop score \>6
* Spontaneous labor/regular contractions on admission
* Rupture of membranes
* Previous uterine scar
* Grandmultiparity (greater than 5 deliveries)
C: Inclusion Criteria:

* All women 18 years of age or greater
* singleton gestation
* vertex presentation
* 37 weeks gestational age or greater
* undergoing an IOL
* bishop score less than or equal to 6
* cervical dilation less than or equal to 2cm

Exclusion Criteria:

* All women less than 18 years of age
* Contraindication for vaginal delivery
* Prior cesarean delivery
* Multiple gestation
* Intrauterine fetal demise
* Fetal anomaly
* HIV
* Unable to consent/ non-English speaking
* Non-reassuring fetal heart rate
* Patients with hemolysis elevated liver enzymes and low platelets
* Eclampsia
* Intrauterine growth restriction (IUGR) 5th percentile with abnormal dopplers
* IUGR less than 10th percentile with reversed end diastolic flow
* Recurrent late decelerations w
* Continuous contractions more than 3 times in 10 minutes at onset of IOL (given that this is a contraindication to misoprostol use at our institution)
* Bishop score is greater than 6
* Cervical dilation greater than or equal to 2cm
* Confirmed ruptured membranes
D: Inclusion Criteria:

* Term or post term pregnancies.
* Live,singleton fetus.
* Cephalic presentation.
* Intact membrane.
* Bishop score \< 6.
* Not in labour.
* Medically indicated for labour induction.
* Primigravida or parity of 3 or less.

Exclusion Criteria:

* Previous caesarean delivery.
* Malpresentation.
* Placenta previa.
* Sever intrauterine growth restriction.
* Multiple pregnancy.
* Polyhydramnios.
* Oligohydramnios.
* Bishop score 7 or more.

Answer: C