Two different regimens of outpatient Foley catheter induction of labor in nulliparas: A randomized trial
Document Type
Article
Publication Date
4-1-2024
Abstract
Objectives: To evaluate expectant compared to immediate return to hospital upon outpatient Foley catheter expulsion predicated on maternal satisfaction and amniotomy-titrated oxytocin infusion to delivery interval.Methods: This randomized trial was conducted in a tertiary university hospital in Malaysia from September 2020 to February 2022. A total of 330 nulliparous women at term with unripe cervices (Bishop score <= 5), singleton viable fetus in cephalic presentation, reassuring preinduction fetal heart rate tracing and intact membranes who underwent planned outpatient Foley catheter induction of labor (IOL) were included. Women were randomized to expectant or immediate return to hospital if the Foley was spontaneously expelled at home before their scheduled hospital admission the following day. Primary outcomes were amniotomy-titrated oxytocin infusion to delivery interval and maternal satisfaction on the induction process (assessed by 0-10 visual numerical rating scale VNRS]).Results: Amniotomy-titrated oxytocin infusion to delivery interval was 8.7 +/- 4.1 versus 8.9 +/- 3.9 h, P = 0.605 (mean difference - 0.228 95% CI: -1.1 to +0.6 h) and maternal satisfaction VNRS score was median (interquartile range) 8 (7-9) versus 8 (7-9), P = 0.782. Early return to hospital rates were 37/165 (22.4%) versus 72/165 (43.6%), RR 0.51 (95% CI: 0.37-0.72), P <= 0.001, Cesarean delivery rates were 80/165 (48.5%) versus 80/165 (48.5%), RR 1.00 (95% CI: 0.80-1.25), P = 1.00 and duration of hospital stay was 54.4 +/- 22.9 versus 56.7 +/- 22.8 h, P = 0.364 for the expectant versus immediate return groups respectively.Conclusion: In outpatient Foley catheter IOL, expectant compared to immediate return to hospital following Foley dislodgement results in similarly high maternal satisfaction. The amniotomy-titrated oxytocin to delivery duration is non-inferior with expectant management.
Keywords
Amniotomy, Cesarean, expectant management, Foley catheter, Maternal satisfaction, Nulliparous, Outpatient labor induction
Divisions
obstetrics
Funders
Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya
Publication Title
International Journal of Gynecology & Obstetrics
Volume
165
Issue
1
Publisher
John Wiley and Sons Ltd
Publisher Location
111 RIVER ST, HOBOKEN 07030-5774, NJ USA