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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
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Publication History

27 November 2018

29 November 2018

Publication Date:
23 January 2019 (online)

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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.

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