A Dhanya Mackeen1, LaToya Walker2, Kelly Ruhstaller2, Meike Schuster2, Anthony Sciscione2. 1. From the Department of Obstetrics and Gynecology at Geisinger Health System in Danville, Pennsylvania (Drs Mackeen and Schuster); Novant Health in Charlotte, North Carolina (Dr Walker); the University of Pennsylvania in Philadelphia (Dr Ruhstaller); and Christiana Care Health System in Newark, Delaware (Dr Sciscione) admackeen@geisinger.edu. 2. From the Department of Obstetrics and Gynecology at Geisinger Health System in Danville, Pennsylvania (Drs Mackeen and Schuster); Novant Health in Charlotte, North Carolina (Dr Walker); the University of Pennsylvania in Philadelphia (Dr Ruhstaller); and Christiana Care Health System in Newark, Delaware (Dr Sciscione).
Abstract
CONTEXT: Although studies support the efficacy of the Foley catheter (FC) as a cervical ripening agent in pregnant women at term with intact membranes, its efficacy has not been well studied in women with premature rupture of membranes (PROM). OBJECTIVE: To compare the interval to delivery in women with PROM who underwent induction of labor and cervical ripening with mechanical (FC) vs nonmechanical (prostaglandin [PG]) cervical ripening agents. DESIGN: Retrospective medical record review at 2 hospitals of pregnant women who delivered between January 2009 and April 2011. SETTING: Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, and Christiana Care Health System in Newark, Delaware. PATIENTS: Pregnant women with singleton gestations 36 weeks or greater who presented with PROM. INTERVENTIONS: Cervical ripening with FC or PG. MAIN OUTCOME MEASURES: The primary outcome was time from induction until delivery. Secondary outcomes included epidural use, maximum temperature during labor, number of vaginal examinations, occurrence of tachysystole, oxytocin dose, delivery mode, chorioamnionitis, and neonatal Apgar score. RESULTS: Of 155 medical records of patients who met the inclusion criteria, 33 women underwent cervical ripening with PG (ie, misoprostol) and 122 with FC. The interval to delivery was almost halved in women who underwent cervical ripening with FC compared with misoprostol (736 vs 1354 minutes; P<.01). Compared with the women in the misoprostol group, those in the FC group received a statistically significant higher dose of oxytocin (P<.01). There were no statistically significant differences between the groups with respect to the remaining secondary outcomes. Of note, all of the women who received FC were from Christiana Care Health System, and all women who received misoprostol were from Thomas Jefferson University Hospital. CONCLUSION: Foley catheters may help shorten the interval to delivery in women who are candidates for cervical ripening after PROM at or near term. There does not appear to be an increased risk for cesarean delivery or chorioamnionitis in those treated with FC.
CONTEXT: Although studies support the efficacy of the Foley catheter (FC) as a cervical ripening agent in pregnant women at term with intact membranes, its efficacy has not been well studied in women with premature rupture of membranes (PROM). OBJECTIVE: To compare the interval to delivery in women with PROM who underwent induction of labor and cervical ripening with mechanical (FC) vs nonmechanical (prostaglandin [PG]) cervical ripening agents. DESIGN: Retrospective medical record review at 2 hospitals of pregnant women who delivered between January 2009 and April 2011. SETTING: Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, and Christiana Care Health System in Newark, Delaware. PATIENTS: Pregnant women with singleton gestations 36 weeks or greater who presented with PROM. INTERVENTIONS: Cervical ripening with FC or PG. MAIN OUTCOME MEASURES: The primary outcome was time from induction until delivery. Secondary outcomes included epidural use, maximum temperature during labor, number of vaginal examinations, occurrence of tachysystole, oxytocin dose, delivery mode, chorioamnionitis, and neonatal Apgar score. RESULTS: Of 155 medical records of patients who met the inclusion criteria, 33 women underwent cervical ripening with PG (ie, misoprostol) and 122 with FC. The interval to delivery was almost halved in women who underwent cervical ripening with FC compared with misoprostol (736 vs 1354 minutes; P<.01). Compared with the women in the misoprostol group, those in the FC group received a statistically significant higher dose of oxytocin (P<.01). There were no statistically significant differences between the groups with respect to the remaining secondary outcomes. Of note, all of the women who received FC were from Christiana Care Health System, and all women who received misoprostol were from Thomas Jefferson University Hospital. CONCLUSION: Foley catheters may help shorten the interval to delivery in women who are candidates for cervical ripening after PROM at or near term. There does not appear to be an increased risk for cesarean delivery or chorioamnionitis in those treated with FC.