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Comparing Foley Catheter to Prostaglandins for Cervical Ripening in Multiparous Women

Published:January 28, 2020DOI:https://doi.org/10.1016/j.jogc.2019.11.001

      Abstract

      Objective

      This study sought to test the hypothesis that among multiparous women requiring cervical ripening, mechanical ripening with a Foley catheter is more effective than prostaglandin preparations.

      Methods

      This was a retrospective analysis of multiparous women with a singleton gestation who required cervical ripening in a single tertiary center from 2014 to 2019. Women who underwent cervical ripening with a Foley catheter (Foley group) were compared with women who underwent cervical ripening using a controlled-release dinoprostone vaginal insert (PGE2-CR group) or dinoprostone vaginal gel (PGE2-gel group). The primary outcome was the ripening-to-delivery interval.

      Results

      A total of 229 women met the study criteria (Foley group: 95; PGE2-CR group: 83; PGE2-gel group: 51). Women in the Foley group had a significantly shorter ripening-to-delivery interval compared with women in the PGE2-CR group (16.2 ± 9.2 hours vs. 27.0 ± 14.8 hours; P < 0.001) and were more likely to deliver within 12 hours (47.4% vs. 12.0%; P < 0.001; adjusted relative risk [aRR] 3.87; 95% confidence interval [CI] 2.07–7.26) and within 24 hours (78.9% vs. 49.4%; P < 0.001; aRR 1.61; 95% CI 1.26–2.06). Women in the Foley group were also less likely to require a second ripening method compared with women in the PGE2-CR group (1.1% vs. 8.4%; P = 0.018; aRR 7.26; 95% CI 2.99–17.62). These differences were not observed when comparing the Foley and the PGE2-gel groups. The cesarean section rate was similar among the Foley group (9.5%), PGE2-CR group (9.6%; P = 0.970), and PGE2-gel group (11.8%; P = 0.664).

      Conclusion

      In multiparous women requiring cervical ripening, all methods of cervical ripening have a similar success rate. However, the use of a PGE2-CR insert is associated with a considerably longer interval to delivery compared with a Foley catheter or PGE2 gel.

      Résumé

      Objectif

      Cette étude cherchait à évaluer l'hypothèse voulant que, chez les femmes multipares devant subir une maturation du col, la maturation mécanique au moyen d'une sonde de Foley soit plus efficace que les préparations de prostaglandines.

      Méthodologie

      Il s'agit d'une analyse rétrospective des femmes multipares dont la grossesse monofœtale nécessitait une maturation du col dans un seul centre tertiaire pour la période de 2014 à 2019. Les femmes qui ont subi une maturation du col au moyen d'une sonde de Foley (groupe Foley) ont été comparées aux femmes qui ont subi une maturation au moyen d'un tampon vaginal de dinoprostone à libération contrôlée (groupe PGE2-tampon) ou de gel vaginal de dinoprostone (groupe PGE2-gel). Le critère de jugement principal était l'intervalle maturation-accouchement.

      Résultats

      Un total de 229 patientes répondaient aux critères de l'étude (groupe Foley : 95; PGE2-tampon : 83; PGE2-gel : 51). Les femmes du groupe Folley ont présenté un intervalle maturation-accouchement plus court comparativement aux femmes du groupe PGE2-tampon (16,2 ± 9,2 heures par rapport à 27,0 ± 14,8 heures; P < 0,001) et étaient plus susceptibles d'avoir accouché dans les 12 heures (47,4 % par rapport à 12,0 %; P < 0,001; risque relatif ajusté [RRa] : 3,87; intervalle de confiance [IC] de 95 % : 2,07–7,26) et dans les 24 heures (78,9 % par rapport à 49,4 %; P < 0,001; RRa : 1,61; IC de 95 % : 1,26–2,06). Les femmes du groupe Foley étaient aussi moins susceptibles de devoir subir une deuxième méthode de maturation comparativement aux femmes du groupe PGE2-tampon (1,1 % par rapport à 8,4 %; P = 0,018; RRa : 7,26; IC de 95 % : 2,99–17,62). Ces différences n'ont pas été observées dans la comparaison des groupes Foley et PGE2-gel. Le taux de césariennes était similaire entre le groupe Foley (9,5 %), le groupe PGE2-tampon (9,6 %; P = 0,970) et le groupe PGE2-gel (11,8 %; P = 0,664).

      Conclusion

      Chez les femmes multipares devant subir une maturation du col, toutes les méthodes de maturation ont un taux de réussite semblable. Cependant, l'utilisation d'un tampon vaginal de PGE2 à libération contrôlée est associée à un intervalle maturation-accouchement considérablement plus long comparativement à l'utilisation de la sonde de Foley et du gel de PGE2.

      Keywords

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