Role of intracervical foley's catheter as pre-induction cervical ripening agent in reducing rate of primary caesarean section

Abstract

Induction of labour may be required for various maternal or foetal reasons at times in the presence of poor Bishop's scoring. Cervical ripening is beneficial in these situations. A randomised comparative analysis was carried out using intracervical Foleys catheter instillation followed by a single dose of dinoprostone gel if required in one group and only dinoprostone gel for ripening in other group. Maternal and neonatal complications, mode of delivery and induction-delivery interval were assessed. We found a higher vaginal delivery rate of 82% in the first group in comparison to 64% in the other group. The difference was statistically significant (p=0.0426). Though a longer induction-delivery interval was observed in the first group, the maternal and foetal outcomes were similar. Intracervical Foley's catheter instillation when used for cervical ripening in unfavourable cervices, either alone or sequentially with dinoprostone gel can significantly reduce the Primary Caesarean section rate without compromising maternal and neonatal safety.

A Comparative Study of Safety & Efficacy of Foley’s Induction with Prostaglandin E2 Gel Induction

“…The mean time interval between time of induction and delivery was significantly lesser in Group 1 compared to Group 2 (14.63±3.42 hours vs. 15.73±2.20 hours; p<0.05). This is in concordance to the study of Malakar A et al, [1] where the induction-delivery interval in group A was 28.58 ± 7.54 hours and in group B it was 24.37 ±9.34 hours. This is comparable to the study of Murthy BK et al, [3] where Induction delivery interval was almost similar in the two groups (11.6 vs 11.1 in dinoprostone and Foleys catheter group respectively).…”

“…1.3% patient in Group 2 had BOH. This is consistent with the studies of Malakar A et al, [1] and Murmu S et al, [2]. Murmu S et al, [2] study observed commonest indication for induction in Foley's and PGE2 gel group was pregnancy induced hypertension which constituted 38.6% in group 1 and 37.1% in group 2.…”

“…It was observed in the present study that the mean gestational age between the groups (39.71±0.89 weeks vs. 39.33±0.30 weeks; p>0.05). Similar findings were seen in study done by Malakar A et al, [1] With mean gestational age in group A was 39.87 ± 0.8 weeks and in group B was 39.66 ± 0.99 weeks. This is also comparable to the Murmu S et al, [2] study which found mean gestational age was 38.4±1.82 weeks in group 1 and 37.9±1.64 weeks in group 2.…”

“…97.4% patients in Group 2 had FTND while 1.3% patient each had LSCS and Ventouse delivery. Malakar A et al, [1] and Murmu S et al, [2] noted similar observations in their studies. Malakar A et al, [1] randomised comparative analysis observed that in groupA, 82% delivered vaginally and 7 out of these required instrument application (14%).…”

“…Other indications for induction of labor were post-dated pregnancy, FGR, decreased fetal movement, oligohydramnios etc. Malakar A et al, [1] randomised comparative analysis found various indications for induction were post-dated pregnancy, term preeclampsia, intrauterine growth restriction, less foetal movement and Rh-negative pregnancy.…”