Outpatient versus inpatient cervix priming with Foley catheter: A randomized trial

Policiano, Catarina; Pimenta, Mariana; Martins, Diana; Clode, Nuno

doi:10.1016/j.ejogrb.2016.11.026

Cited by 38 publications

(71 citation statements)

References 19 publications

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“…The use of Foley catheter for cervical ripening did not result in signi cant improvement in the Bishop score. This was in contrast to our study whereby the improvement was signi cant in the outpatient group (13,14). The reason was unclear as the initial Bishop score was similar in all these studies.…”

Section: Discussioncontrasting

confidence: 96%

“…The safety of Foley catheter cervical ripening was apparent as there were neither NICU admission nor meconium aspiration syndrome and there was no signi cant difference in the incidence of neonatal sepsis. Not surprisingly, the caesarean delivery rate was similar between the two groups which were in agreement with the previous published studies (12)(13)(14). However, one study showed signi cantly higher rate of caesarean section due to failed labor induction in the outpatient group (13).…”

Section: Discussionsupporting

confidence: 91%

“…The reason was unclear as the initial Bishop score was similar in all these studies. The outpatient group required signi cantly shorter duration of hospital stay which concurred with study by Wilkinson et al and Policiano et al as a result of later admission and higher Bishop score in the second assessment (13,14). Additionally, there were no cases of born-before arrival which is consistent with other studies (9,14,15).…”

Section: Discussionsupporting

confidence: 89%

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Prospective randomized controlled trial comparing inpatient and outpatient Foley catheter cervical ripening

Rahman

Mohamad

Kalok

et al. 2020

Preprint

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Background To evaluate the safety of Foley catheter cervical ripening and patients’ satisfaction in outpatient versus inpatient setting. Methods Sixty low risk women were randomized to outpatient (n = 25) and inpatient (n = 35) cervical ripening using Foley catheter. In both groups Foley catheter with 60 ml balloon was digitally inserted through the cervix with gentle traction applied. The outpatient group was discharged home after provision of verbal and written 24-hours contact information and instructions. The inpatient group was admitted to the ward. They were reassessed the next morning unless labor had begun or the catheter had dropped off. Results The demographic data between the two groups did not differ. The outpatient group has significant improvement in the Bishop score at second assessment (9.04 versus 7.89, p = 0.04), reduced duration of inpatient stay (41 versus 59, p < 0.001), able to sleep 5–6 hours (9 versus 1, p = 0.001), able to rest (23 versus 16, p = 0.001) and relax (23 versus 10, p < 0.001). Significantly, more women in the inpatient group had wished to be in the outpatient group (3 versus 21, p < 0.001). There was no difference in initial Bishop score, duration of oxytocin infusion and delivery within 24 hours. Both groups were similar in caesarean section rate, total blood loss, maternal and neonatal infection, primary postpartum hemorrhage, neonatal birthweight and cord pH. There was no incidence of uterine hyperstimulation, meconium aspiration syndrome and neonatal intensive care unit admission. Conclusion Outpatient Foley catheter cervical ripening had comparable efficacy and safety with inpatient for low-risk pregnancies and associated with better patient satisfaction. Trial registration: NCT04342741. It was retrospectively registered with ClinicalTrial.gov

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

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Prospective randomized controlled trial comparing inpatient and outpatient Foley catheter cervical ripening

Rahman

Mohamad

Kalok

et al. 2020

Preprint

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“…4 Given the prevalence and length of this IP procedure, some have suggested an alternative-outpatient (OP) cervical ripening. [5][6][7][8][9][10][11][12][13][14][15] Evidence suggests that OP cervical ripening is safe in appropriately chosen patients and is associated with improved patient satisfaction. The safety of OP transcervical balloons is demonstrated by the low rate of adverse events in many studies, including multiple randomized controlled trials (RCTs).…”

mentioning

confidence: 99%

Outpatient Cervical Ripening: A Cost-Minimization and Threshold Analysis

et al. 2019

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Objective To evaluate cost of outpatient (OP) versus inpatient (IP) ripening with transcervical balloons, and determine circumstances in which each strategy would be cost saving. Study Design We created a decision model comparing OP and IP balloon ripening in term (≥37 weeks) singleton pregnancies with unfavorable cervix. We performed a cost-minimization analysis and threshold analyses comparing two OP ripening strategies (broad and limited use) to IP ripening from a health system perspective. Base case estimates of probability, utilization, and cost were derived from the literature. The primary outcome was incremental cost of OP versus IP ripening from a hospital perspective. One- and two-way sensitivity analyses explored uncertainty in the model. Results Both OP ripening strategies were cost saving compared with IP ripening: incremental cost −$228.40/patient with broad use and −$73.48/patient with limited use. OP ripening was no longer cost saving if hours saved on labor and delivery (L&D) were <3.5, insertion visit cost >$714, or facility cost/hour on L&D <$61. Two-way sensitivity analyses showed that OP ripening was cost saving under the most plausible clinical circumstances. Conclusion In patients with unfavorable cervix, OP transcervical balloon ripening was cost saving under a wide range of circumstances, particularly if OP ripening can shorten time spent on L&D by 3.5 hours.

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“…There are commercially available Foley catheters that are designed to hold higher volumes, as were used in the trial by Gu et al Until the safety concerns can be assessed, these catheters should be preferred over smaller balloons that are filled past capacity. Increased volume in the Foley catheter may increase discomfort, lead to more nursing intervention during the ripening period, and may steer providers away from more non‐intervention settings (outpatient ripening) . Although these issues have not been studied, they remain theoretical concerns.…”

Section: Discussionmentioning

confidence: 99%

Increased single‐balloon Foley catheter volume for induction of labor and time to delivery: a systematic review and meta‐analysis

Schoen

Saccone

Backley

et al. 2018

Acta Obstet Gynecol Scand

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Outpatient versus inpatient cervix priming with Foley catheter: A randomized trial

Cited by 38 publications

References 19 publications

Prospective randomized controlled trial comparing inpatient and outpatient Foley catheter cervical ripening

Prospective randomized controlled trial comparing inpatient and outpatient Foley catheter cervical ripening

Outpatient Cervical Ripening: A Cost-Minimization and Threshold Analysis

Increased single‐balloon Foley catheter volume for induction of labor and time to delivery: a systematic review and meta‐analysis

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