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Grand Rounds

RCT Results: Does Adding a Weight to the Foley Used for Induction of Labor Improve Outcomes?

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BACKGROUND AND PURPOSE:

  • Cherian et al. (International Journal of Gynecology and Obstetrics. 2022) assessed the effectiveness of attaching a weight to a Foley catheter for labor induction

METHODS:

  • Randomized controlled trial
  • Participants
    • ≥39 weeks | Singleton live fetus | Cephalic
    • Admitted for induction of labor with an unfavorable cervix
  • Interventions
    • 30 ml Foley catheter
    • 30 ml Foley with a 500 ml weight
  • Study design
    • Foley filled with 30 ml of saline
    • Weight: 500 ml of saline attached to the end of the Foley and hung over the edge of the bed
    • AROM and oxytocin 12 hours after Foley insertion
    • If Foley expelled <12 hours and not in active labor: AROM done 12 hours after Foley insertion and oxytocin started
  • Sample size calculation
    • 80% power
    • Reduction of cesarean section for failed induction from 20% to 10% with the use of Foley with weight
    • Two-sided test (α error 5%)
    • 199 participants required in each arm  
  • Primary outcome
    • Prevention of lower segment cesarean section for failed induction

RESULTS:

  • Foley: 200 women | Foley with weight: 199 women
  • There was no difference in proportion of mode of delivery between groups
    • Foley: 17.1%
    • With wight: 17.5%
    • 95% CI, 0.98 (0.63 to 1.49); P=0.913
  • There was no statistically significant difference in cesarean section rates for failed induction between groups
    • Foley: 26.5%
    • Foley with weight: 45.7%
    • P=0.1
  • There was a shorter time to Foley expulsion with weight attachment
    • Foley: 10.9 ± 3.2 hours
    • Foley with weight: 2.6 ± 3.3 hours
    • P<0.001
  • Shorter time to expulsion did not translate to a difference in
    • Time to active labor
    • Time to delivery
    • Difference in number of women who attained a Bishop score of ≥6

CONCLUSION:

  • The addition of a weight to the Foley catheter did not reduce the rate of cesarean delivery due to failed induction
  • The authors state that

… the added effort of placing a weight and the restriction of the woman’s movement seem unwarranted

Learn More – Primary Sources:

Induction of labor using Foley catheter with weight attached versus without weight attached: A randomized control trial

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Related ObG Topics:

RCT Results: Does Early AROM Following Foley Expulsion Reduce Time to Delivery? 
RCT Results: Can Outpatient Cervical Ripening with Foley Decrease Time from Admission to Delivery?
2021 Cochrane Review: Oral Misoprostol vs Other Labor Induction Methods

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