Foley catheter or vaginal prostaglandin E2 gel—which is the better option for induction in women with unfavorable cervix at term? According to new research, the Foley catheter may be a better choice.
Dr Marta Jozwiak, from Groene Hart Hospital in Gouda, Netherlands, and colleagues from the PROBAAT Study group conducted an open-label, randomized, multisite controlled trial. The women (N=824) were recruited from 12 hospitals across the Netherlands and were included in the study if they had a term singleton pregnancy in cephalic presentation, intact membranes, an unfavorable cervix, and an indication for induction of labor. None of the women had a history of cesarean section.
Jozwiak et al. used an online randomization system to assign women to induction of labor with a 30 ml Foley catheter or vaginal prostaglandin E2 gel; equal numbers of women were assigned to each group. To determine which option might be most appropriate, the researchers compared C-section rates, maternal morbidity, neonatal morbidity, and time from intervention to birth.
The researchers found that C-section rates were comparable across the Foley catheter and prostaglandin groups, with slightly more women in the catheter group having C-sections (23% versus 20%, respectively). Jozwiak et al. determined the risk ratio to be 1.13.
Overall, both methods for induction were deemed relatively safe for the women, as Jozwiak and colleagues only found two serious maternal adverse events. Specifically, they found one uterine perforation and one uterine rupture; both events were found among women in the group receiving vaginal prostaglandin. Based on admissions to neonatal intensive care units and Apgar scores, the researchers determined that neonatal morbidity was similar across the two groups.
While none of the women met the criteria for failed induction, Jozwiak et al. noted that the median time from start of labor induction until birth was significantly longer when the Foley catheter was used for induction, with median time until birth in the catheter group taking 29 hours as compared to 18 hours for the prostaglandin group.
With labor induction occurring in as many as 20% of all deliveries, clinicians and researchers seek to find safe and effective methods that lead to successful deliveries. Based on their findings, Jozwiak and colleagues noted the Foley catheter is a good option for women with an unfavorable cervix at term. They wrote, “Induction of labour with a Foley catheter is similar to induction of labour with prostaglandin E2 gel, with fewer maternal and neonatal side-effects.”
Jozwiak M, Oude Rengerink K, Benthem M, et al. Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial. Lancet. 2012;378(9809):2095-103.