BACKGROUND AND PURPOSE:

• Ausbeck et al. (Obstetrics & Gynecology, 2020) examined whether outpatient Foley catheter cervical ripening in nulliparous women shortens the time from admission to delivery

METHODS:

• Randomized controlled trial
• Participants
  • Singleton pregnancies
  • Nulliparous
  • Elective labor induction at ≥39 weeks
  • Modified Bishop score <5
• Intervention
  • Outpatient transcervical Foley
    • Inserted the day before admission for scheduled induction
  • Inpatient transcervical Foley
    • Inserted at scheduled admission
• Power analysis
  • 126 participants (63 in each group) required to detect at least a 5-hour mean difference in the primary outcome
  • 80% power | Two-sided alpha of 0.05
• Primary outcome
  • Duration of time from admission to delivery

RESULTS:

• 126 participants, 63 in each group
  • Baseline characteristics were balanced between the two groups, except that the following were lower in the outpatient group
    • BMI: 31±5.4 vs 34±7.5 (P=.01)
    • Group B streptococcus colonization: 31% vs 54% (P=.01)
• The time from admission to delivery was shorter in the outpatient group
  • Outpatient: 17.4±7.4 hours
  • Inpatient: 21.7±9.1 hours
  • Mean difference 4.3 hours (95% CI 1.3 to 7.2); P<0.01
• Admissions before scheduled induction were higher in the outpatient group
  • Outpatient: 22%
  • Inpatient: 5%
  • Relative risk 4.7 (95% CI 1.4 to 15.4); P<0.01
• Median modified Bishop score on admission was also higher in the outpatient group (P<0.01)
  • Outpatient: score of 3
  • Inpatient: score of 1
• There was no significant difference in
  • Cesarean delivery (P=0.32)
    • Outpatient: 24%
    • Inpatient: 32%
    • RR 0.8 (95% CI 0.4 to 1.3)
  • Chorioamnionitis (P=0.16)
    • Outpatient: 22%
    • Inpatient: 13%
    • RR 1.8 (95% CI 0.8 to 3.9)

CONCLUSION:

• Outpatient Foley catheter for cervical ripening decreased time from admission to delivery for nulliparous women undergoing elective labor induction at term
• The authors do caution that

Larger studies are needed to evaluate cesarean delivery, infection, and other safety outcomes

Learn More – Primary Sources:

Outpatient Foley Catheter for Induction of Labor in Nulliparous Women: A Randomized Controlled Trial

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