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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Article info
Publication history
Published online: January 28, 2020
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.