Please select the eligibility criteria that correspond to the clinical trial below.
Title: Sequential Versus Concurrent Use of Vaginal Misoprostol Plus Foley Catheter for Induction of Labor
Brief Summary: to compare between sequential and concurrent use of vaginal misopristol plus foleys catheter for induction of labor


Options:
A: Inclusion Criteria:

1. Spontaneous rupture of membranes (ROM) ≥1 hour prior to starting induction; ROM defined as clinical history with the presence of 2 of the following 4: pooling, ferning, nitrazine, oligohydramnios. In the absence of clinical history, oligohydramnios AND pooling must be present for ROM to be diagnosed. Oligohydramnios is defined as a total amniotic fluid index of \<5cm or a maximum vertical pocket \<2cm.
2. Unfavorable cervix, defined as sterile digital exam ≤ 2cm dilated / 80% effaced
3. Gestational age ≥ 34 weeks by best obstetric estimate
4. Clinical management decision is vaginal delivery
5. Singleton gestation
6. Cephalic presentation
7. Willing to participate and able to understand and sign the informed consent document before randomization
8. Women of reproductive age

Exclusion Criteria:

1. Multiple gestations
2. Lethal fetal anomalies, e.g., anencephaly, trisomy 13, trisomy 18
3. Latex allergy
4. Greater than 1 prior cesarean delivery
5. Active labor - defined as contractions more frequent than every 5 minutes (or ≥ 12 contractions in 1 hour) associated with ≥ 1 cm cervical change. In the absence of ≥ 1 cm cervical change after 2 hours, patients with contractions can be included in the study.
6. Suspicion of chorioamnionitis
7. Any contraindications to vaginal delivery, including malpresentation, active herpes, complete placenta previa, greater than two prior cesarean deliveries, etc.
8. HIV positive status or AIDS
9. Intrauterine fetal demise
10. Suspected placental abruption, significant hemorrhage
11. Nonreassuring fetal heart rate (FHR) pattern
12. Participation in a competing trial
B: Inclusion Criteria

* Term 37 weeks or more, singleton in cephalic presentation
* Age 18 years and older
* Patient admitted for induction of labor

Exclusion Criteria:

* Malpresentation
* Preterm labor less than 37 weeks of gestation
* Patients with fetal anomalies
* Premature rupture of membranes
* If the cervix is closed and unable to place the foley bulb
* Multiple gestation
* Non-reassuring fetal heart tracing
* Contraindication to misoprostol
* Contraindication to vaginal delivery (i.e. placenta previa, vasa previa, active vaginal bleeding, marginal previa, macrosomia, etc). History of prior uterine surgery such as cesarean section or myomectomy
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:

* Indication for labour induction Term pregnancy with alive fetus Bishop score less than five

Exclusion Criteria:

* Age less than 18 years Previous uterine scar Nonvertex presentation Non-reassuring fetal status Fetal anomalies Fetal growth restriction Genital bleeding Tumors, malformations and/or ulcers of vulva, perineum or vagina

Answer: D