Am J Perinatol 2019; 36(14): 1528-1532
DOI: 10.1055/s-0038-1677473
Commentary
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Foley Catheter for Outpatient Cervical Ripening: Review of the Evidence and a Proposed Model of Care

Lisa D. Levine
1   Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
,
Anthony C. Sciscione
2   Department of Obstetrics and Gynecology, Christiana Hospital, Newark, Delaware
› Author Affiliations
Further Information

Publication History

27 November 2018

29 November 2018

Publication Date:
23 January 2019 (online)

Induction of labor is one of the most common obstetrical procedures in pregnancy with more than 20% of women undergoing an induction of labor annually in the United States.[1] [2] A recent randomized trial has shown that nulliparous women who routinely have their labor induced at 39 weeks' gestation have a decreased risk of cesarean delivery, preeclampsia, and respiratory distress of the neonate.[3] If this clinical paradigm is universally adopted, the number of women undergoing induction of labor is expected to rise significantly. This would add a substantial resource and space burden to labor delivery suites and antepartum areas where induction of labor, but most importantly, preinduction cervical ripening takes place. An outpatient approach to induction of labor, specifically in women with an “unripe” cervix, is attractive if it is safe, effective and provides high patient satisfaction. Outpatient cervical ripening has already been adopted in other countries outside of the United States.[4] [5] [6] [7]

Routinely, women with an unfavorable cervix undergo cervical ripening prior to an induction of labor.[2] [8] Cervical ripening is often a lengthy process equating to a considerable amount of time spent in the hospital preparing the cervix for medical induction of labor. In an effort to decrease the resources and expense associated with inpatient cervical ripening, studies have examined the use of outpatient cervical ripening. The Foley catheter, because of its mechanical nature and low side effect profile, is a lead candidate. Our recent article,[9] along with others,[10] [11] reviewed the safety of cervical ripening with the Foley catheter and implications for outpatient use. In this commentary, we will summarize safety information from multiple studies and present additional benefits to outpatient cervical ripening. We include an algorithm of care for institutions and hospitals that wants to adopt this for clinical practice.

Supplementary Material

 
  • References

  • 1 Center for Disease Control and Prevention. Recent declines in induction of labor. Available at: http://www.cdc.gov/nchs/data/databriefs/db155.htm . Accessed March 1, 2016
  • 2 American College of Obstetrics and Gynecology Practice Bulletin. Induction of labor. Number 107, August 2009; Reaffirmed 2016
  • 3 Grobman WA, Rice MM, Reddy UM. ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal—Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018; 379 (06) 513-523
  • 4 Sharp AN, Stock SJ, Alfirevic Z. Outpatient induction of labour in the UK: a survey of practice. Eur J Obstet Gynecol Reprod Biol 2016; 204: 21-23
  • 5 Barnfield L, Neale E, Reynolds S. Outpatient cervical ripening in a district general hospital: a five-year retrospective cohort study. J Obstet Gynaecol 2018; 38 (03) 301-304
  • 6 Sutton C, Harding J, Griffin C. Patient attitudes towards outpatient cervical ripening prior to induction of labour at an Australian tertiary hospital. J Obstet Gynaecol 2016; 36 (07) 921-928
  • 7 Leduc D, Bringer A, Lee L, Dy J. Induction of Labor. SOGC Clinical Practice Guideline. 2013; No. 296. J Obstet Gynaecol Can 2015; 37 (04) 380-381
  • 8 Grobman WA. Predictors of induction success. Semin Perinatol 2012; 36 (05) 344-347
  • 9 Leopold B, Sciscione A. Is there a place for outpatient preinduction cervical ripening?. Obstet Gynecol Clin North Am 2017; 44 (04) 583-591
  • 10 Amorosa JM, Stone JL. Outpatient cervical ripening. Semin Perinatol 2015; 39 (06) 488-494
  • 11 Kelly AJ, Alfirevic Z, Dowswell T. Outpatient versus inpatient induction of labour for improving birth outcomes. Cochrane Database Syst Rev 2009; 15 (02) CD007372
  • 12 Leduc D, Biringer A, Lee L, Dy J. ; CLINICAL PRACTICE OBSTETRICS COMMITTEE; SPECIAL CONTRIBUTORS. Induction of labour. J Obstet Gynaecol Can 2013; 35 (09) 840-857
  • 13 Thomas J, Fairclough A, Kavanagh J, Kelly AJ. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database Syst Rev 2014; 19 (06) CD003101
  • 14 Wilkinson C, Bryce R, Adelson P, Turnbull D. A randomised controlled trial of outpatient compared with inpatient cervical ripening with prostaglandin E2 (OPRA study). BJOG 2015; 122 (01) 94-104
  • 15 Fox NS, Saltzman DH, Roman AS, Klauser CK, Moshier E, Rebarber A. Intravaginal misoprostol versus Foley catheter for labour induction: a meta-analysis. BJOG 2011; 118 (06) 647-654
  • 16 Sciscione AC, Nguyen L, Manley J, Pollock M, Maas B, Colmorgen G. A randomized comparison of transcervical Foley catheter to intravaginal misoprostol for preinduction cervical ripening. Obstet Gynecol 2001; 97 (04) 603-607
  • 17 Vogel JP, Osoti AO, Kelly AJ, Livio S, Norman JE, Alfirevic Z. Pharmacological and mechanical interventions for labour induction in outpatient settings. Cochrane Database Syst Rev 2017; 9 (09) CD007701
  • 18 Sciscione AC, Bedder CL, Hoffman MK, Ruhstaller K, Shlossman PA. The timing of adverse events with Foley catheter preinduction cervical ripening; implications for outpatient use. Am J Perinatol 2014; 31 (09) 781-786
  • 19 Levine LD, Downes KL, Elovitz MA, Parry S, Sammel MD, Srinivas SK. Mechanical and pharmacologic methods of labor induction: a randomized controlled trial. Obstet Gynecol 2016; 128 (06) 1357-1364
  • 20 McMaster K, Sanchez-Ramos L, Kaunitz AM. Evaluation of a transcervical Foley catheter as a source of infection: a systematic review and meta-analysis. Obstet Gynecol 2015; 126 (03) 539-551
  • 21 Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M. Mechanical methods for induction of labour. Cochrane Database Syst Rev 2012; 14 (03) CD001233
  • 22 Diederen M, Gommers J, Wilkinson C, Turnbull D, Mol B. Safety of the balloon catheter for cervical ripening in outpatient care: complications during the period from insertion to expulsion of a balloon catheter in the process of labour induction: a systematic review. BJOG 2018; 125 (09) 1086-1095
  • 23 Dowswell T, Kelly AJ, Livio S, Norman JE, Alfirevic Z. Different methods for the induction of labour in outpatient settings. Cochrane Database Syst Rev 2010; 4 (08) CD007701
  • 24 Jozwiak M, ten Eikelder M, Oude Rengerink K. , et al; PROBAAT Study Group. Foley catheter versus vaginal misoprostol: randomized controlled trial (PROBAAT-M study) and systematic review and meta-analysis of literature. Am J Perinatol 2014; 31 (02) 145-156
  • 25 Sciscione AC, Muench M, Pollock M, Jenkins TM, Tildon-Burton J, Colmorgen GH. Transcervical Foley catheter for preinduction cervical ripening in an outpatient versus inpatient setting. Obstet Gynecol 2001; 98 (5 Pt 1): 751-756
  • 26 Policiano C, Pimenta M, Martins D, Clode N. Outpatient versus inpatient cervix priming with Foley catheter: a randomized trial. Eur J Obstet Gynecol Reprod Biol 2017; 210: 1-6
  • 27 Henry A, Madan A, Reid R. , et al. Outpatient Foley catheter versus inpatient prostaglandin E2 gel for induction of labour: a randomised trial. BMC Pregnancy Childbirth 2013; 13 (25) 25
  • 28 Biem SR, Turnell RW, Olatunbosun O, Tauh M, Biem HJ. A randomized controlled trial of outpatient versus inpatient labour induction with vaginal controlled-release prostaglandin-E2: effectiveness and satisfaction. J Obstet Gynaecol Can 2003; 25 (01) 23-31
  • 29 Howard K, Gerard K, Adelson P, Bryce R, Wilkinson C, Turnbull D. Women's preferences for inpatient and outpatient priming for labour induction: a discrete choice experiment. BMC Health Serv Res 2014; 14 (330) 330
  • 30 Kuper SG, Jauk VC, George DM. , et al. Outpatient Foley catheter for induction of labor in parous women: a randomized controlled trial. Obstet Gynecol 2018; 132 (01) 94-101
  • 31 Adelson PL, Wedlock GR, Wilkinson CS, Howard K, Bryce RL, Turnbull DA. A cost analysis of inpatient compared with outpatient prostaglandin E2 cervical priming for induction of labour: results from the OPRA trial. Aust Health Rev 2013; 37 (04) 467-473
  • 32 Austin K, Chambers GM, de Abreu Lourenco R, Madan A, Susic D, Henry A. Cost-effectiveness of term induction of labour using inpatient prostaglandin gel versus outpatient Foley catheter. Aust N Z J Obstet Gynaecol 2015; 55 (05) 440-445
  • 33 McKenna DS, Duke JM. Effectiveness and infectious morbidity of outpatient cervical ripening with a Foley catheter. J Reprod Med 2004; 49 (01) 28-32