TITLE:
Induction of Labor with a Transcervical Foley Catheter in an Outpatient Setting in a Low-Risk Population: A Retrospective Cohort Study
AUTHORS:
Sara Ardabili, Anton Fiedler, Vincent Uerlings, Dirk Lehnick, Markus Hodel, Corina Christmann
KEYWORDS:
Outpatient Induction of Labor, Cervical Ripening, Balloon Catheter, Foley Catheter, Misoprostol
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.16 No.7,
July
27,
2026
ABSTRACT: Background: Induction of labor (IOL) is one of the most common obstetric interventions. While in previous years IOL has primarily been performed in an inpatient setting, outpatient approaches have gained increasing interest in recent years. Since October 2019 the insertion of a Foley catheter in an outpatient setting is the first-line choice for IOL in low-risk situations in our department. If labor cannot be induced within 24 hours, IOL will be continued in an inpatient setting with oral misoprostol or oxytocin and amniotomy, depending on the Bishop score. The aim of this study was to evaluate our standard IOL regimen concerning effectiveness and safety. Methods: Data were collected retrospectively from all deliveries in our department from October 2019 until December 2020 that had primarily been induced with a Foley catheter in an outpatient setting. Effectiveness was evaluated by assessment of the time interval between Foley insertion and delivery and the need for further induction methods after the Foley catheter. Safety was evaluated by assessment of the presence of adverse events at time of hospitalization after outpatient IOL with the Foley catheter such as pathological CTG, uterine hyperstimulation, vaginal bleeding or chorioamnionitis. In addition, general maternal and neonatal outcome parameter were evaluated. Results: We included a total of 120 women in our analysis. Among the women, 66.7% were primiparous, 24.2% delivered their second child, and 9.1% their third or fourth. The main indications for IOL were late-term or postterm pregnancy (32.5%), suspected fetal macrosomia (12.5%) and oligohydramnios (10.8%). At time of hospitalization, there were no pathological changes in fetal heart rate, vaginal bleeding, chorioamnionitis or uterine hyperstimulation in any of the cases analyzed (upper limit of 95% CI 3.0%). No further induction method after the Foley catheter was needed in 20.8% (95% CI 13.9 - 29.1%). 26.7% of the women (95% CI 18.9% - 35.5%) did not require misoprostol to achieve the onset of labor. Vaginal delivery was achieved in 75.8% of the women (95% CI 67.2% - 83.2%), 24.2% (95% CI 16.9% - 32.8%) sustained a caesarean section. The mean time interval between insertion of the catheter and delivery was 38.1 hours and the mean time of inpatient stay 4 days. There occurred no serious neonatal or maternal adverse events directly related to the IOL with the Foley catheter in our cohort. Conclusions: In this retrospective cohort of low-risk pregnancies, IOL with an outpatient Foley catheter was associated with favorable maternal and neonatal outcomes and no observed serious adverse events directly related to the Foley catheter. These findings provide descriptive information on the implementation of an outpatient Foley catheter induction regimen in clinical practice. Further studies with comparative designs are needed to evaluate the effectiveness and safety of this approach further and to determine its possible applicability beyond low-risk situations.