Download PDF
Am J Perinatol 2018; 35(10): 1001-1005
DOI: 10.1055/s-0038-1635091
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Association between Cervical Exam after Ripening with Foley Balloon Catheter and Outcomes of Nulliparous Labor Induction

Ashley N. Battarbee
1   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
Anna Palatnik
2   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Danielle A. Peress
3   Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
William A. Grobman
4   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations Funding None.
Further Information

Publication History

02 September 2017

21 January 2018

Publication Date:
28 February 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Objective Evaluate the association between cervical examination after ripening with Foley catheter and labor induction outcomes.

Materials and Methods In this retrospective cohort, nulliparous women with singleton, viable gestation undergoing cervical ripening with Foley catheter were compared based on cervical status after catheter removal or expulsion: favorable (modified Bishop score ≥ 5) or unfavorable (score < 5). Bivariable and multivariable analyses were performed to determine whether cervical examination postripening was associated with time to delivery and chance of vaginal delivery.

Results A total of 774 women were eligible. Women with favorable examination postripening had lower body mass index (BMI) and more favorable admission cervical examination. The frequency of vaginal delivery was higher in women with favorable cervical examination postripening (57.9% versus 46.8%, p < 0.01). Median durations from Foley removal or expulsion to complete dilation (8.6 h versus 11.5 h) and vaginal delivery (10.4 h versus 13.2 h) were shorter for women with favorable cervical examination postripening (p < 0.001). In multivariable analysis, favorable examination postripening remained associated with vaginal delivery (adjusted odds ratio 1.39, 95% confidence interval 1.04–1.87), and time to vaginal delivery (adjusted hazard ratio 1.39, 95% confidence interval 1.13–1.70).

Conclusion A favorable modified Bishop score after cervical ripening with Foley balloon catheter is associated with higher chance of vaginal delivery and shorter labor duration.

Keywords

Bishop score - Foley balloon catheter - labor induction - nulliparous

Condensation

The modified Bishop score after cervical ripening with a Foley balloon catheter is associated with chance of vaginal delivery and duration of labor induction.


Note

This study was presented in the poster format at the 63rd annual meeting of the Society for Reproductive Investigation, Montreal, QC, Canada, March 16–19, 2016.


 

  • References

  • 1 Osterman MJK, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief, No. 155. Hyattsville, MD: National Center for Health Statistics; 2014
    Google Scholar
  • 2 Yeast JD, Jones A, Poskin M. Induction of labor and the relationship to cesarean delivery: A review of 7001 consecutive inductions. Am J Obstet Gynecol 1999; 180 (3 Pt 1): 628-633
    CrossrefPubMedGoogle Scholar
  • 3 Carbone JF, Tuuli MG, Fogertey PJ, Roehl KA, Macones GA. Combination of Foley bulb and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and labor induction: a randomized controlled trial. Obstet Gynecol 2013; 121 (2 Pt 1): 247-252
    CrossrefPubMedGoogle Scholar
  • 4 Gelber S, Sciscione A. Mechanical methods of cervical ripening and labor induction. Clin Obstet Gynecol 2006; 49 (03) 642-657
    CrossrefPubMedGoogle Scholar
  • 5 Levine LD, Downes KL, Elovitz MA, Parry S, Sammel MD, Srinivas SK. Mechanical and pharmacologic methods of labor induction. Obstet Gynecol 2016; 128 (06) 1357-1364
    CrossrefPubMedGoogle Scholar
  • 6 Connolly KA, Kohari KS, Rekawek P. , et al. A randomized trial of Foley balloon induction of labor trial in nulliparas (FIAT-N). Am J Obstet Gynecol 2016; 215 (03) 392.e1-392.e6
    CrossrefPubMedGoogle Scholar
  • 7 Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol 1964; 24: 266-268
    PubMedGoogle Scholar
  • 8 ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114 (2 Pt 1): 386-397
    CrossrefPubMedGoogle Scholar
  • 9 Ananth CV, Schisterman EF. Confounding, causality, and confusion: the role of intermediate variables in interpreting observational studies in obstetrics. Am J Obstet Gynecol 2017; 217 (02) 167-175
    CrossrefPubMedGoogle Scholar
  • 10 Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 2011; 117 (04) 805-811
    CrossrefPubMedGoogle Scholar
  • 11 Osmundson S, Ou-Yang RJ, Grobman WA. Elective induction compared with expectant management in nulliparous women with an unfavorable cervix. Obstet Gynecol 2011; 117 (03) 583-587
    CrossrefPubMedGoogle Scholar