(843) Digital versus speculum-guided catheter balloon insertion for cervical ripening in multiparas: A randomized controlled trial

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Induction of labor is an increasingly common obstetric procedure. Catheter balloon insertion is routinely speculum-guided but digital insertion has been reported previously although not found more tolerable in nulliparas. We aimed to evaluate pain score and maternal satisfaction of digital vs speculum-guided foley catheter balloon insertion for labor induction in multiparas.

Study Design: A randomized trial was performed in a single tertiary university-affiliated hospital. Participants were multiparas (parity>1), presenting at term with bishop < 6 for induction of labor. Excluded were nulliparas and women who have had previous cesarean section. Participants were randomized to digital or speculum-guided foley catheter insertion. Primary outcomes were pain score (visual scale analog score 0-10) and maternal satisfaction (visual scale analog score 1-5). Secondary outcomes were procedure duration, cervical ripening (bishop>6), delivery mode, delivery within 24 hours, infection rate and neonatal outcome.

Results: 100 women were randomized into 50 digitally-inserted and 50 speculum-guided insertion. Median pain score (VAS) was 4 (0-10) and 7 (0-10), respectively, p< 0.001 (box plot, figure 1), and maternal satisfaction score (VAS) was 5 (3-5) and 4 (1-5), respectively, p=0.01. Multivariate analysis showed that digital insertion (p=0.009) and increased parity (p=0.001) independently decreased VAS score. Median procedure duration was 2.1 (1.4-5.3) and 3.0 (1.4-5.0), p< 0.001 for digital vs. speculum-guided insertion. Cervical ripening, delivery mode, infections and neonatal outcome were not significantly different between the groups (table 1).

Conclusion: Digital insertion of foley catheter for cervical ripening in multiparas is less painful, better tolerated and quicker than the speculum-guided method. It is also not inferior in terms of cervical ripening and infectious morbidity. Since our goal is to increase women's satisfaction with the induction-of-labor procedure, manual insertion of the catheter should be considered. Implementation of this technique among staff should be studied in further research.

Coauthor(s)

Raneen Abu Shqara, MD
Resident
Galilee Medical Center, Bar Ilan University
Nahariyya, HaZafon, Israel
YN
Yara Nakhlah, MD
Galilee Medical Center
Nahariyya, HaZafon, Israel
HH
Habib Haj, MD
Galilee Medical Center
Nahariyya, HaZafon, Israel
SM
Sofya Markdorf, MD
Galilee Medical Center
Nahariyya, HaZafon, Israel
LL
Lior Lowenstein, MD
Galilee Medical Center
Nahariya, HaZafon, Israel

Primary & Presenting Author(s)

Maya Wolf, MD
Director of Maternal-Fetal Unit
Galilee Medical Center
Nahariya, HaZafon, Israel