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Cervical ripening with Foley catheter for induction of labor after cesarean section: a cohort study.

Jozwiak M, van de Lest HA, Burger NB, Dijksterhuis MG, De Leeuw JW.

 Acta Obstet Gynecol Scand. 2013 Dec 16. doi: 10.1111/aogs.12320. [Epub ahead of print]

Editor’s comment: Prof. Jim Thornton: Is labour induction via Foley catheter after previous Cesarean section safe?
This paper purports to show that induction via Foley catheter after previous Cesarean section is safe. However, among 208 such cases, two term babies died, one after uterine rupture, and six babies (3%) had birth asphyxia as evidenced by an Apgar below 7 at 5 minutes.

Abstract

OBJECTIVE:

To evaluate spontaneous vaginal delivery and complication rates after induction of labor with a transcervical Foley catheter in women with a previous cesarean delivery.

DESIGN:

Retrospective cohort study.

SETTING:

Secondary teaching hospital in the second largest city of the Netherlands.

POPULATION:

Women with a history of cesarean delivery (n = 208), undergoing induction of labor with a Foley catheter in a subsequent pregnancy.

MATERIAL AND METHODS:

The women who had induction of labor with a transcervical Foley catheter in the Ikazia Hospital, Rotterdam, between January 2003 and January 2012, were identified in a computerized database. Patient's records were checked for accuracy.

MAIN OUTCOME MEASURES:

Vaginal delivery rate, cesarean section rate, uterine rupture and maternal and neonatal (infectious) morbidity.

RESULTS:

Of the women 60% had a spontaneous vaginal delivery and 11% were delivered by vacuum extraction. Uterine rupture occurred in one woman. Postpartum hemorrhage was the most common maternal complication (12%). Maternal intrapartum and postpartum infections occurred in 5% and 1%. Proven neonatal infection was found in 3% of the cases. Two perinatal deaths occurred (1%), of which one was related to uterine rupture.

CONCLUSION:

Induction of labor with a transcervical Foley catheter is an effective method to achieve vaginal delivery in women with a previous cesarean delivery. There is a low risk of uterine rupture and maternal and neonatal (infectious) morbidity in this cohort.

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Commentaries by Editor Prof. Jim Thornton