Cervical Ripening Using Foley Balloon with or without Oxytocin: A Systematic Review and Meta-Analysis

Lauren T. Gallagher; Benjamin Gardner; Mahbubur Rahman; Corina Schoen; Katherine A. Connolly; Gary D. Hankins; George R. Saade; Antonio F. Saad

doi:10.1055/s-0038-1668577

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(04): 406-421
DOI: 10.1055/s-0038-1668577

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cervical Ripening Using Foley Balloon with or without Oxytocin: A Systematic Review and Meta-Analysis

Authors

Lauren T. Gallagher

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
Benjamin Gardner

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
Mahbubur Rahman

²Support Unit for Conducting Clinically Essential Studies, OMURA Susumu & Mieko Memorial, St. Luke's Center for Clinical Academia, St. Luke's International University, Tokyo, Japan
Corina Schoen

³Division of Maternal-Fetal Medicine, University of Massachusetts-Baystate, Springfield, Massachusetts
Katherine A. Connolly

⁴Division of Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
Gary D. Hankins

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
George R. Saade

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
Antonio F. Saad

¹Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas

Abstract

Objective To assess available evidence regarding the use of oxytocin in conjunction with Foley balloon (FB) for cervical ripening.

Methods Databases from MEDLINE (U.S. National Library of Medicine, 1980—May 12, 2017), MEDLINE (Ovid, 1980—June 30, 2017), the Cochrane Library Controlled Trials Register, ClinicalTrials.gov, and Web of Science were queried for studies on FB cervical ripening with or without oxytocin in pregnant women. Search terms included: “balloon dilatation” OR “mechanical methods” OR “mechanical method” OR “mechanical dilation” OR “mechanical dilatation” OR “mechanical dilations” OR “mechanical dilatations” OR “balloon” OR “Foley” AND “Pitocin” OR “oxytocin.” All relevant references were reviewed. Literature for inclusion and methodological quality were reviewed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

Results Out of 344 citations, six randomized clinical trials (1,133 patients) fulfilled our inclusion criteria. The pooled estimate showed that the cesarean delivery (CD) rate did not differ (relative risk [RR]: 0.91 (95% confidence interval [CI] [0.76–1.10]; p = 0.23) between patients who underwent preinduction cervical ripening with FB alone versus those who received oxytocin in addition to FB. Heterogeneity was not significant among studies (I ² 0.0%; p = 0.64). Furthermore, no differences in other outcomes such as composite and maternal outcomes were detected between these two groups. Compared with simultaneous use of oxytocin with FB, the Foley alone cervical ripening group had a longer induction to delivery time, and lower deliveries within 12 and 24 hours. Subgroup analysis showed that only multiparous women in the Foley alone group had lower rate of vaginal delivery within 24 hours (RR: 0.74, 95% CI [0.61–0.89], p = 0.002) along with a trend toward higher CD rates.

Conclusion Adding oxytocin to FB at the time of preinduction cervical ripening does not reduce cesarean rates nor improve maternal or neonatal outcomes. Multiparous women who received FB alone seem to have lower rates of vaginal deliveries within 24 hours, but these results should be interpreted with caution.

Keywords

preinduction - oxytocin - Foley - cervical ripening - induction - labor - cesarean

Full Text

References

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