Foley Catheter Induces Labor as Effectively as Vaginal Gel

For the induction of labor, use of a Foley catheter appears as efficient as vaginal prostaglandin E2 gel, but with fewer side effects, according to a new study.

Researchers at Leiden University Medical Center (LUMC; The Netherlands) conducted a randomized study that included 824 women in 12 Dutch hospitals with a term, singleton pregnancy and indication for induction of labor. The patients were randomized to either open-label use of Foley catheter or up to 3 mg of vaginal prostaglandin E2 gel. All women had cephalic presentation, intact membranes, and an unfavorable cervix without any prior cesarean section. None failed induction with their assigned method, but 15 patients did not receive the intervention in the Foley catheter group, most of them due to inability to insert the catheter.

The results showed that women spent longer in labor after induction with the Foley catheter, at a median of 29 hours until birth, compared with 18 hours in the prostaglandin group, which appeared to be due to a later onset of active labor. Eventual Cesarean delivery rates were equal for both Foley catheter and prostaglandin gel use; most C-sections were done for failure to progress during the first stage of labor, which was also more common with Foley catheter induction. The rate of delivery with vaginal instruments was similar between groups, but the procedure tended to occur more often for fetal distress in the prostaglandin group. Operative delivery due to fetal distress was less common with the Foley catheter than with the prostaglandin.

“We think that some cesarean sections done for labor arrest in the Foley catheter group might have been done because of impatience of the attending obstetrician,” explained lead author Kitty Bloemenkamp, MD. “This could especially be the case with obstetricians to whom Foley catheter use was new and who might have believed that use of prostaglandins was preferential.”

Mechanical methods to prepare the cervix for birth are among the oldest approaches known, but pharmacological methods have since replaced them in many first world countries, due to concerns of perforation and maternal infection. The Foley catheter is used to inflate a balloon behind the cervical wall that simulates the pressure of a baby's head to encourage the cervix to dilate, likely by stimulating endogenous prostaglandins.

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