TITLE:
Foley Balloon Catheter versus Oral Misoprostol for Induction of Labour after Prelabour Rupture of Membranes: A Retrospective Data Analysis
AUTHORS:
Anna Bouwknegt, Sjuul Jongen, Kim Kamphorst, Maria G. van Pampus, Paul J. Q. van der Linden, Joost J. Zwart
KEYWORDS:
Prelabour Rupture of Membranes (PROM), Balloon Catheter, Misoprostol, Cervical Ripening, Labour Induction, Chorioamnionitis
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.7,
July
13,
2022
ABSTRACT: Objectives: The Foley balloon catheter (FC) is a viable method for cervical ripening,
but concerns about infection risk restrict its use in cases of prolonged
prelabour rupture of membranes (PROM). This study aims to evaluate
the efficacy and safety of the FC compared to oral misoprostol for cervical
ripening after PROM. Study Design: A retrospective data-analysis
of 128 pregnant women was conducted. Of these, 49 underwent cervical ripening
with an FC and 79 with oral misoprostol. We included all
women with a vital singleton pregnancy at 37 - 42 weeks of gestation who underwent cervical ripening after ≥ 24 hours of
PROM in specific time frames in two Dutchsecondary care and teaching hospitals.
The primary outcome was the incidence of intrapartum infection, a composite of
maternal and neonatal infection. In addition, we evaluated the mode of
delivery, duration of priming and priming-to-delivery interval. Secondary endpoints included uterine hyperstimulation, umbilical cord
prolapse, birth weight, Apgar scores, length of admission to the neonatal low
dependency unit, admission to the (neonatal) Intensive Care Unit (ICU) and
mortality. Statistical analyses included bivariate and multivariate techniques. Results: Cervical ripening with FC,
compared with oral misoprostol, showed a higher incidence
of intrapartum infection, respectively 32.7% (n = 16) vs. 12.7% (n = 10) (p = 0.006).
However, after adjusting for epidural anaesthesia and pregestational BMI, the
association was no longer significant. No difference was found in mode of
delivery and total priming-to-delivery interval (median 21.3 hours vs. 22.0, p = 0.897).
Furthermore, FC, compared with oral misoprostol, showed a longer duration of
cervical ripening and hence a shorter duration of active labour (p 0.001). Apart
from the 1-min Apgar score, secondary maternal and neonatal outcomes did not
differ between the groups. Conclusion: In women who require
cervical ripening after prolonged PROM at term, the
FC and oral misoprostol are similar in terms of efficacy and safety. Advantages associated with the FC are its safe application in women with
a history of caesarean section, although we did not study these women, and an
implied shorter duration of active labour. Our study adds to the limited
available data on the use of the FC after the rupture of membranes and a large randomized controlled trial is needed to strengthen our findings.