Induction of labour with intracervical Foley catheter in an outpatient setting: a retrospective analysis

Introduction Induction of labour (IOL) is one of the most common obstetric interventions. A mechanical method is the intracervical inserted Foley catheter (FC). According to the ACOG guidelines, the FC can be considered for low-risk pregnancies in an outpatient setting. Due to a shorter inpatient stay, higher patient satisfaction and cost effectiveness are described. Since October 2019 insertion of a FC in the outpatient setting is primarily used in low-risk situations at our institution. If labour cannot be inducted within 24 hours, women are admitted for IOL and continued with oral misoprostol or oxytocin and amniotomy, depending on the Bishop score.

Methods From October 2019 until December 2020, we retrospectively analysed all deliveries in our hospital that had primarily been induced with FC in the outpatient setting. Low-risk pregnancies were defined as following: women≥37 weeks of gestation, a maximum of three previous vaginal deliveries and no prior caesarean section, a singleton pregnancy in cephalic position and intact membranes.

Results We included 120 out of 190 women. Women with an unsigned general consent form (n=69) and one case of discontinued IOL were excluded.

In our population 66.7% of the women were primiparous, 24.2% expected their second child, and 9.1% their third or fourth. The main indications for IOL were postdate (32.5%), fetal macrosomia (12.5%) and oligohydramnios (10.8%). No further induction method after FC was used in 20.8%, 26.7% did not require misoprostol. Vaginal delivery was achieved in 75.8% of the women, 20.8% needed vaginal-operative assistance and 24.2% received a caesarean section. The average time span from FC-insertion to birth was 38.1 hours, the average time of inpatient stay 4 days.

There was no case of pathological changes in fetal heart rate at time of hospitalization. No uterine hyperstimulation nor severe maternal events were recorded. Except one case of early onset sepsis there were no severe neonatal events.

Discussion In low-risk situations the insertion of FC in the outpatient setting is a safe and effective method of IOL. Our caesarean section rate is similar to the existing literature. Further research in a prospective setting is planned.

Publication History

Article published online:
26 November 2021