Eden Manly1, Liran Hiersch2, Alexandra Moloney1, Anne Berndl1, Elad Mei-Dan3, Arthur Zaltz1, Jon Barrett1, Nir Melamed4. 1. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON. 2. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON; Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, North York General Hospital, Toronto, ON. 4. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON. Electronic address: nir.melamed@sunnybrook.ca.
Abstract
OBJECTIVE: This study sought to test the hypothesis that among multiparous women requiring cervical ripening, mechanical ripening with a Foley catheter is more effective than prostaglandin preparations. METHODS: This was a retrospective analysis of multiparous women with a singleton gestation who required cervical ripening in a single tertiary center from 2014 to 2019. Women who underwent cervical ripening with a Foley catheter (Foley group) were compared with women who underwent cervical ripening using a controlled-release dinoprostone vaginal insert (PGE2-CR group) or dinoprostone vaginal gel (PGE2-gel group). The primary outcome was the ripening-to-delivery interval. RESULTS: A total of 229 women met the study criteria (Foley group: 95; PGE2-CR group: 83; PGE2-gel group: 51). Women in the Foley group had a significantly shorter ripening-to-delivery interval compared with women in the PGE2-CR group (16.2 ± 9.2 hours vs. 27.0 ± 14.8 hours; P < 0.001) and were more likely to deliver within 12 hours (47.4% vs. 12.0%; P < 0.001; adjusted relative risk [aRR] 3.87; 95% confidence interval [CI] 2.07-7.26) and within 24 hours (78.9% vs. 49.4%; P < 0.001; aRR 1.61; 95% CI 1.26-2.06). Women in the Foley group were also less likely to require a second ripening method compared with women in the PGE2-CR group (1.1% vs. 8.4%; P = 0.018; aRR 7.26; 95% CI 2.99-17.62). These differences were not observed when comparing the Foley and the PGE2-gel groups. The cesarean section rate was similar among the Foley group (9.5%), PGE2-CR group (9.6%; P = 0.970), and PGE2-gel group (11.8%; P = 0.664). CONCLUSION: In multiparous women requiring cervical ripening, all methods of cervical ripening have a similar success rate. However, the use of a PGE2-CR insert is associated with a considerably longer interval to delivery compared with a Foley catheter or PGE2 gel.
OBJECTIVE: This study sought to test the hypothesis that among multiparous women requiring cervical ripening, mechanical ripening with a Foley catheter is more effective than prostaglandin preparations. METHODS: This was a retrospective analysis of multiparous women with a singleton gestation who required cervical ripening in a single tertiary center from 2014 to 2019. Women who underwent cervical ripening with a Foley catheter (Foley group) were compared with women who underwent cervical ripening using a controlled-release dinoprostone vaginal insert (PGE2-CR group) or dinoprostone vaginal gel (PGE2-gel group). The primary outcome was the ripening-to-delivery interval. RESULTS: A total of 229 women met the study criteria (Foley group: 95; PGE2-CR group: 83; PGE2-gel group: 51). Women in the Foley group had a significantly shorter ripening-to-delivery interval compared with women in the PGE2-CR group (16.2 ± 9.2 hours vs. 27.0 ± 14.8 hours; P < 0.001) and were more likely to deliver within 12 hours (47.4% vs. 12.0%; P < 0.001; adjusted relative risk [aRR] 3.87; 95% confidence interval [CI] 2.07-7.26) and within 24 hours (78.9% vs. 49.4%; P < 0.001; aRR 1.61; 95% CI 1.26-2.06). Women in the Foley group were also less likely to require a second ripening method compared with women in the PGE2-CR group (1.1% vs. 8.4%; P = 0.018; aRR 7.26; 95% CI 2.99-17.62). These differences were not observed when comparing the Foley and the PGE2-gel groups. The cesarean section rate was similar among the Foley group (9.5%), PGE2-CR group (9.6%; P = 0.970), and PGE2-gel group (11.8%; P = 0.664). CONCLUSION: In multiparous women requiring cervical ripening, all methods of cervical ripening have a similar success rate. However, the use of a PGE2-CR insert is associated with a considerably longer interval to delivery compared with a Foley catheter or PGE2 gel.