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Grand Rounds

Does Adding a Foley to Oxytocin Following PROM Improve Time to Delivery?

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BACKGROUND AND PURPOSE:

  • Mechanical cervical ripening may improve time to delivery following prelabor rupture of membranes (PROM) but there may be risk of infection
  • Mackeen et al. (Obstetrics & Gynecology, 2018) compared the use of a transcervical Foley catheter plus oxytocin infusion versus oxytocin infusion alone for labor induction and cervical ripening

METHODS:

  • Randomized, multicenter controlled trial
  • Participants: Women with a live, singleton gestation ≥34 weeks with
    • PROM
    • Unfavorable cervical examination (≤2 cm or ≤80% effaced)
    • No contraindication to labor
      • In the absence of ≥1 cm cervical dilation after 2 hours, patients with contractions could be included in the study
    • Participants were randomized as follows
      • Transcervical Foley catheter inflated to 30 cc with concurrent oxytocin infusion
        • Placed/taped under tension
      • Oxytocin infusion alone
    • Initial oxytocin was 2 milliunits/min and increased by 2 milliunits/min every 30 minutes to achieve an adequate contraction pattern
      • Maximum dose of 30 milliunits/min
    • Chorioamnionitis defined as temperature ≥38°C (or 100.4°F) and ≥2 or more of the following
      • Uterine tenderness | Maternal tachycardia ≥100 BPM | Fetal tachycardia ≥160 BPM | Foul smelling amniotic fluid | Maternal leukocytosis > 15,000 cells/mL
    • Antibiotics
      • Group B streptococci prophylaxis or clinically suspected intraamniotic infection as indicated
    • Primary study outcome
      • Interval from induction to delivery
    • Secondary outcomes
      • Mode of delivery
      • Maternal and newborn outcomes

RESULTS:

  • 201 women were enrolled in the study
    • 93 were allocated to Foley group
    • 108 to oxytocin group
  • Time to delivery was not significantly different between groups (P=.69)
    • Foley group: 13.9 hours (±6.9 SD)
    • Oxytocin group: 14.4 hours (±7.9 SD)
  • There were more cases of clinical chorioamnionitis (8% compared with 0%, P<.01) in the Foley group compared with the oxytocin group

CONCLUSION:

  • The introduction of Foley in addition to oxytocin did not shorten time between induction and delivery but did introduce risk for chorioamnionitis
  • Limitations
    • Study used clinical assessment of infection and not placental pathology (1/3 of case underwent pathologic review)
  • However, authors state that the study was adequately powered to determine a difference in chorioamnionitis and the results of this study “should make us question whether use of a Foley catheter is appropriate in those with ruptured membranes”

Learn More – Primary Sources:

Foley Plus Oxytocin Compared With Oxytocin for Induction After Membrane Rupture: A Randomized Controlled Trial.

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Related ObG Topics:

Foley vs Misoprotol:  What is the Most Cost-Effective Way to Induce Labor?
The FIAT-M study: Simultaneous or Sequential Foley and Oxytocin for Induction in Multiparous Women
Does Stopping Oxytocin in Active Phase of Labor Alter Cesarean Section Rates?

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