INTRODUCTION:
We sought to determine if parity and starting effacement predict successful induction of labor (IOL), defined as achievement of complete cervical dilation (ACD), when utilizing Foley Balloon (FB) for IOL.
METHODS:
A retrospective study with IRB approval was conducted of all singleton pregnancies undergoing IOL between 2013 and 2016 at a single institution. Stillbirths and prior cesarean delivery (CD) were excluded. Primary outcome was ACD. Secondary outcomes were CD, postpartum hemorrhage, chorioamnionitis, and NICU admission. Starting effacement was stratified into quartiles: 0-25%, 26-50%, 51-75%, and 76-100%, and parity divided into nulliparous and multiparous groups. Multivariate logistic regression were performed to assess the effect of parity and starting effacement on the rate of ACD.
RESULTS:
Of the 1,260 patients that met inclusion criteria, 615 had starting effacement between 0-25% with a mean parity of 1.0. In nulliparous women with starting effacement 0-25% receiving FB for IOL, 50.4% (68) ACD, compared to 69.0% (116) in the same group not receiving FB (P<0.001, OR 0.45; 95th CI: 0.28-0.73). The CD rate was also higher in nulliparous women receiving FB (54.8% v 34.9%, P<0.001, OR: 2.3; 95th CI: 1.4-3.6) compared to nulliparous women not receiving FB. In multiparous women with starting effacement 0-25% receiving FB for IOL, 84.8% (56) ACD, compared to 86.2% (219) in the same group not receiving FB (P=0.69, OR 0.86; 95th CI: 0.4-1.8). There were no statistically significant differences in the secondary outcomes.
CONCLUSION:
Nulliparous patients with low starting effacement may benefit from additional medications, rather than placement of FB for IOL.
the last 60-90min. Given concerns about the safety of uterine overstimulation, we need to determine whether the supraphysiologic intrauterine pressures generated in augmented labor are necessary to achieve a vaginal delivery.
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