Safety, Efficacy, and Patient Satisfaction of Cervical Ripening With Transcervical Use of the Foley Catheter in an Outpatient Setting

Objective:

To compare inpatient versus outpatient preinduction cervical ripening in order to evaluate differences between each setting with respect to patient safety, satisfaction and cesarean rate.

Background:

Many women who require induction of labor present with an unripe cervix. This has been associated with a longer duration of labor as well as higher rates of failed induction resulting in cesarean delivery. These patients are also at higher risk for postpartum hemorrhage, blood transfusion, and cesarean hysterectomy. Preinduction cervical ripening is thought to improve the likelihood of a successful induction in women with an unripe cervix. Prolonged inductions of labor do not only lead to patient dissatisfaction but also use valuable resources such as available labor and delivery bed and nursing staff. This in turn overburdens labor and delivery resources which are already taxed. These issues contribute to increasing costs as well as decreasing patient satisfaction.

Prior studies have shown that moving preinduction cervical ripening from an inpatient setting to an outpatient setting can decrease costs significantly. It is also thought that 50% of all patients requiring induction of labor may be eligible for outpatient cervical ripening. Many of these studies have looked at PGE two preparations which are no longer commonly used. However, a study by Scisione et al. from November 2001 looked at the use of Trent cervical Foley catheter for this purpose. They had previously shown that a mechanical method, the Foley catheter, had significant advantages over preparations such as prepidil. Scisione et al. had also previously shown that in a randomized trial comparing misoprostol and Foley catheter for preinduction cervical ripening both were found to be equally effective. However, in the group who received the misoprostol, there was an increased risk of meconium passage in uterine contractile abnormalities.