Maternal and neonatal outcomes by cervical ripening agent
For full-term, low-risk, nulliparous patients, induction of labor with a Foley balloon alone or concurrent with prostaglandins (PGE) is associated with a significantly lower risk of adverse neonatal outcomes than with PGE alone, according to a study in the American Journal of Perinatology. The length of labor and delivery was also the shortest with concurrent Foley-oxytocin.

“Many pregnant women undergo induction of labor in everyday clinical practice,” said the primary author “There is a wide variety or combination of methods that are used in cervical ripening; however, the safest and most efficacious method is not yet established.”

Of the 6,106 participants comprising the ARRIVE trial, 38.9% met the criteria for this analysis. Participants were excluded for preripening membrane rupture, abruption, chorioamnionitis, fetal demise or cervical dilation equal to or more than3.5 cm. Of the cohort for analysis, 52.4% had cervical ripening with PGE; 12.2% had Foley-PGE; 16.2% had Foley alone, and 19.1% had Foley-oxytocin. The maternal composite outcome was similar for all 4 groups. The neonatal composite outcome was attained significantly less often for those who received Foley-PGE or Foley alone: 2.4% and 3.6%, respectively.

Participants who received Foley-PGE or Foley-oxytocin also had a shorter labor and delivery stay compared with PGE: an adjusted mean difference of -1.97 hours and -5.92 hours, respectively. Moreover, participants were not randomly assigned to the type of cervical ripening that they received, but rather to the type of cervical ripening method used per the discretion of the attending physician. “Therefore, randomized trials are needed to validate our results,” Andrikopoulou said.