Outpatient Foley catheter versus inpatient prostaglandin E2 gel for induction of labour: a randomised trial

Abstract

BackgroundInduction of labour (IOL) is one of the commonest obstetric interventions, with significant impact on both the individual woman and health service delivery. Outpatient IOL is an attractive option to reduce these impacts. To date there is little data comparing outpatient and inpatient IOL methods, and potential safety concerns (hyperstimulation) if prostaglandins, the standard inpatient IOL medications, are used in the outpatient setting. The purpose of this study was to assess feasibility, clinical effectiveness and patient acceptability of outpatient Foley catheter (OPC) vs. inpatient vaginal PGE2 (IP) for induction of labour (IOL) at term.MethodsWomen with an unfavourable cervix requiring IOL at term (N = 101) were randomised to outpatient care using Foley catheter (OPC, n = 50) or inpatient care using vaginal PGE2 (IP, n = 51). OPC group had Foley catheter inserted and were discharged overnight following a reassuring cardiotocograph. IP group received 2 mg/1 mg vaginal PGE2 if nulliparous or 1 mg/1 mg if multiparous. Main outcome measures were inpatient stay (prior to birth, in Birthing Unit, total), mode of birth, induction to delivery interval, adverse reactions and patient satisfaction.ResultsOPC group had shorter hospital stay prior to birth (21.3 vs. 32.4 hrs, p < .001), IP were more likely to achieve vaginal birth within 12 hours of presenting to Birthing Unit (53% vs. 28%, p = .01). Vaginal birth rates (66% OPC Vs. 71% IP), total induction to delivery time (33.5 hrs vs. 31.3 hrs) and total inpatient times (96 hrs OPC Vs. 105 hrs IP) were similar. OPC group felt less pain (significant discomfort 26% Vs 58%, p = .003), and had more sleep (5.8 Vs 3.4 hours, p < .001), during cervical preparation, but were more likely to require oxytocin IOL (88 Vs 59%, p = .001).ConclusionsOPC was feasible and acceptable for IOL of women with an unfavourable cervix at term compared to IP, however did not show a statistically significant reduction in total inpatient stay and was associated with increased oxytocin IOL.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN:12609000420246.

Comparison of the efficacy of extra amniotic Foley catheter, intravaginal prostaglandin E1 tablet and intracervical prostaglandin E2 gel for pre induction cervical ripening: a randomized comparative study

“…In the study by Henry et al in an Australian tertiary hospital, intracervical Foley balloon was compared with intracervical dinoprostone among women with a need for cervical ripening and Bishop Score of less than seven. 7 Kosinka et al compared intracervical Foley with intracervical dinoprostone at a University hospital in Poland. 8 They included women with a bishop score of less than six.…”

“…6 In the study by Henry et al the mean induction to delivery interval was 33.5 hours in the Foley group and 31.1 hours in the dinoprostone group, which was not statistically significant (p=0.402). 7 Kosinka et al in their study mentioned the initiation of ripening to delivery interval in minutes. 8 It was 1682±2387 minutes in the Foley group and 920±600 minutes in the intracervical dinoprostone group.…”

“…6 Henry et al and Kosinka et al did not include post ripening bishop score as a variable for analysis in their study. 7,8 However, as Bishop Score is very subjective, a more objective method of cervical ripening assessment should be used to overcome observer related bias.…”

Cervical ripening and induction of labour: Inpatient or outpatient, oral misoprostol or Foley catheter?

“…As it does not need intensive maternal or fetal monitoring, and is safe and effective for induction of labour if kept in situ for four days, according to currently available evidence, a supra cervical Foley catheter could be considered as an appropriate method for outpatient induction of labour [8,10,12,13]. Most women who have received outpatient cervical ripening have been very positive and satisfied with their experience, especially those who were able to self-administer vaginal isosorbide mononitrate and thus have had greater involvement and control over the process in a comfortable and supportive home environment.…”

Induction of Labour in women with Nonscarred Uterus Using Balloon Catheter: Randomised Controlled Trial

“…Foley catheter is a low cost method that can induce labour with less risk to the fetus [2,3,5,8,11].Usually Foley catheter is used for bladder drainage, but also, can be inserted into the cervix and balloon inflated by saline, then the catheter is gently traced by strapping it to the mother's thigh. It is then left for 12 hoursor until it falls out through the cervical os [3,7].…”