Outpatient vs inpatient Foley catheter induction of labor in multiparas with unripe cervixes: A randomized trial

Abstract

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Evidence Based Management of Labor

“…A recent randomized controlled trial of low-risk nulliparous patients undergoing elective induction of labor found that outpatient Foley reduced the time from admission to delivery (17.4 ± 7.4 vs 21.7 ± 9.1 hours) by a mean of 4.3 hours (95% CI, 1.3–7.2; P < 0.01) 41 . A similar study in multiparous patients demonstrated no difference in time from admission to delivery 42 . Given that the duration of intrapartum stay is the key cost driver in inductions, interventions such as outpatient ripening that decrease the intensity and time of intrapartum care should be cost saving.…”

“…41 A similar study in multiparous patients demonstrated no difference in time from admission to delivery. 42 Given that the duration of intrapartum stay is the key cost driver in inductions, interventions such as outpatient ripening that decrease the intensity and time of intrapartum care should be cost saving. Based on the data available, we can recommend that low-risk patients with planned induction of labor should be recommended outpatient Foley, to reduce time to delivery in nulliparous patients and reduce cost of hospitalization among both nulliparous and multiparous patients.…”

Early versus delayed amniotomy with immediate oxytocin after Foley catheter cervical ripening in multiparous women with labor induction: A randomized controlled trial

“…6 Foley catheter labor induction in multiparas with unripe cervixes is usually performed without significant uterine contractions and is well tolerated; labor contractions can be initiated by amniotomy and titrated oxytocin infusion. 7 With a favorable cervix, combined use of amniotomy and intravenous oxytocin is generally the most effective approach 8 and is more successful than other agents in achieving vaginal delivery within 24 h. 9 Early amniotomy during IOL is associated with faster time to delivery without any evidence of adverse perinatal outcomes. 10 A systematic review (17 trials with 2566 women) on concurrent amniotomy with intravenous oxytocin shows potential synergistic effects, with fewer women being undelivered vaginally at 24 h when compared with amniotomy alone.…”

“…Cervical ripening with Foley catheter in IOL is highly recommended by the World Health Organization 1 and is often used because of its low cost, stability at room temperature, and reduced risk of uterine tachysystole 6 . Foley catheter labor induction in multiparas with unripe cervixes is usually performed without significant uterine contractions and is well tolerated; labor contractions can be initiated by amniotomy and titrated oxytocin infusion 7 . With a favorable cervix, combined use of amniotomy and intravenous oxytocin is generally the most effective approach 8 and is more successful than other agents in achieving vaginal delivery within 24 h 9 .…”

“…Delivery rate at 4 h and 6 h after oxytocin infusion were 40 of 116 (35%) versus 22 of 116 (19%) (relative risk [RR], 1.82 [95% confidence interval (CI), 1.16-2.86], P = 0.011) and 77 of 116 (66%) versus 54 of 116 (47%) (RR, 1.43 [95% CI, 1.13-1.80], P = 0.003) for the early versus delayed amniotomy arms, respectively. Maternal satisfaction on birth process were 7 (IQR,(6)(7)(8) versus 7 (IQR, 7-8) (P = 0.006), uterine hyperstimulation rates were 10 of 116 (9%) versus 14 of 116 (12%) (RR, 0.71 [95% CI, 0.33-1.54]) (P = 0.519), and Cesarean delivery rates were 17 of 116 (15%) versus 19 of 116 (16%) (RR, 0.90 [95% CI, 0.49-1.63], P = 0.856) for the early versus delayed amniotomy arms, respectively.…”