Abstract
Objective We sought to assess the safety of transcervical Foley catheter (TCF) placement for
cervical ripening in women undergoing induction of labor (IOL) after prior cesarean
by evaluating the risk of uterine rupture.
Study Design We performed a secondary analysis of the Maternal-Fetal Medicine Unit's Cesarean
Section Registry, a prospective observational cohort study. We included women with
a history of ≤2 low-transverse cesarean deliveries who underwent IOL at ≥24 weeks
of gestational age with a live singleton fetus without major anomalies. We excluded
those who received prostaglandins or laminaria. We performed multinomial logistic
regression to calculate adjusted odds ratios (aORs) for uterine rupture and dehiscence.
Relevant confounders included prior vaginal delivery, pregnancy-induced hypertension,
chorioamnionitis, and cervical effacement and dilation on admission.
Results A total of 2,564 women were eligible. Unadjusted analysis demonstrated no increased
risk of uterine rupture with TCF (1.9 vs. 0.9%; p = 0.10) but an increased risk of uterine dehiscence (1.9 vs. 0.6%; p = 0.02). After adjustment, TCF was not associated with an increased risk of uterine
rupture (aOR: 2.02; 95% confidence interval [CI]: 0.71–5.78) or uterine scar dehiscence
(aOR: 1.32; 95% CI: 0.37–4.72).
Conclusion Foley catheter is a safe tool for mechanical dilation in women undergoing IOL after
prior cesarean.
Keywords
cervical ripening - induction of labor - TOLAC - VBAC
