Efficacy and Safety of Foley Catheter Balloon for Cervix Priming in Term Pregnancy

Abstract

Introduction: Foley catheter promotes cervix priming by a direct mechanical effect of distension.Material and Methods: A prospective observational study was conducted at a tertiary hospital, including all cases of induction of labor with Foley catheter between September 1, 2013 and November 30, 2015. Women were eligible if they had a singleton pregnancy with a Bishop score < 6 and a gestational age ≥ 41 weeks or a medical indication for induction of labor. The primary outcome was the Bishop score variation (difference between Bishop score before and after insertion of Foley catheter). Mode of delivery, induction-to-delivery time, uterine tachysystole with fetal decelerations, peripartum fever ≥ 38º C, maternal pain and mortality were also analyzed.Results: Within 201 inductions with Foley catheter, average increase in Bishop score after catheter placement was three (1 - 7), with only 5% (11/201) of unmodified cervix after catheter removal/extrusion. Vaginal delivery rate was 71% (142/201) and in women with a previous cesarean section (n = 40) was 37% (15/40). Average induction-to-delivery time was 38 hours (4 - 120). Uterine infection rate was 3% (6/201). There was only one case of significant vaginal bleeding which required immediate catheter removal. There has been no significative maternal or neonatal morbidity.Discussion/Conclusion: Foley catheter is a safe and effective method of cervical priming for women with an unfavorable cervix, even in the case of a previous cesarean delivery.

Cesarean Section Rate Analysis in a Tertiary Hospital in Portugal According to Robson Ten Group Classification System

“…2,3,16,18,20 One possible reason for this achievement may be the policy adopted by the Department of using Foley catheter as a mechanical method for cervical priming and labor induction in women with one previous uterine scar which allows vaginal births with no documented increase on maternal or neonatal morbidity. 24 The number of deliveries in this group has increased over time, reflecting the number of primary CSs and of > 1 previous CS performed in the past. 17,22 Since in Portugal women may choose the public maternity where they want to deliver, it is possible that the knowledge of the lower CS rate in our institution and particularly in this group might have had influence on this choice.…”

Application effect of single balloon catheters in labor induction of pregnant women in late-term pregnancy and their influences on stress and inflammatory responses

“…It has been reported that single balloon catheter can cause reproductive tract infection after insertion; thus, strict aseptic operation is imperative ( 9 ). A recent study has confirmed that the effect of cervical single balloon expansion in promoting cervical ripening is relatively better, and it can effectively shorten the stage of labor and improve the natural delivery rate with high safety ( 10 ). Cervical expansion of a single balloon catheter has a higher natural labor rate and lower delivery rate of cesarean section than that of the double balloon catheter, rendering the former more suitable for clinically promoting cervical ripening ( 11 ).…”

Robson Classification System Applied to Induction of Labor

“…In the past, transcervical Foley catheter was replaced by pharmacological agents, but recently it has showed promising results, either alone or in combination with other methods, especially when used with unfavorable Bishop scores. [17][18][19] Oxytocin is a commonly used method for IL worldwide, either alone or in combination with other methods. However, when used alone, it is less effective than intravaginal prostaglandins.…”

“…In the past, transcervical Foley catheter was replaced by pharmacological agents, but recently it has showed promising results, either alone or in combination with other methods, especially when used with unfavorable Bishop scores. 17 18 19 …”

“…Much like what has been reported by other studies, group 5 revealed the highest CS rate, even higher than expected. 18 19 21 22 These results are connected to the fear of uterine rupture and to the difficulty of choosing an IL method that is not contraindicated and, therefore, that is also less effective. 23 24 Despite the small size of this group ( n = 66), it was the second biggest contributor (17.6%) to the overall CS rate.…”