(528) Association between Foley balloon for cervical ripening and chorioamnionitis among patients with GBS colonization

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: Our objective was to investigate whether the use of a Foley balloon as a cervical ripening agent for induction of labor in patients with GBS colonization increases the risk of developing chorioamnionitis (chorio).

Study Design: This was a secondary analysis of a randomized trial comparing induction methods. Patients with a term, singleton gestation, intact membranes and an unfavorable cervix (Bishop score of ≤6 and dilation ≤2) were included in the original trial. Only patients positive for GBS colonization (by culture, history, or UTI) were included in this analysis. Patients received third trimester GBS screening and intrapartum antibiotic prophylaxis per ACOG guidelines. Labor management was standardized for the trial. The primary outcome was chorio (maternal fever and antibiotic treatment), compared between those who received a Foley (+/- other agent) versus those who received prostaglandin only. Secondary outcomes were postpartum infection (endometritis, wound infection) and neonatal morbidity. A Cox proportional hazards model was used to evaluate risk while accounting for length of time with ruptured membranes (ROM).

Results: Of the 491 subjects in the original trial, 182 (38.9%) were GBS positive: 133 (73.1%) received a Foley; 49 (26.9%) received prostaglandin only. There were no differences in demographic or baseline clinical characteristics between the groups although labor characteristics differed (Table). The overall rate of chorio was 8.2% with no difference between Foley vs. no Foley in Cox proportion models accounting for time with ROM (HR 1.72, 95% CI 0.38-7.73). There was also no difference in postpartum infection (p=0.54) or neonatal morbidity (p=0.46).

Conclusion: In this secondary analysis of a large randomized trial with standardized labor management, we found no increased risk of chorio, postpartum infection, or neonatal morbidity among GBS positive patients who received a Foley balloon during their induction of labor compared to prostaglandin.

Primary & Presenting Author(s)

Kira A. Bromwich, MD (she/her/hers)
University of Pennsylvania
Philadelphia, Pennsylvania, United States

Coauthor(s)

Jennifer A. McCoy, MD, MSCE (she/her/hers)
Assistant Professor
Maternal Fetal Medicine Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania, United States
Alison G. Cahill, MD, MSCI
Professor
University of Texas at Austin, Dell Medical School
Austin, Texas, United States
Anthony C. Sciscione, DO
Program Director
Delaware Center for Maternal & Fetal Medicine of Christiana Care, Inc.
Newark, Delaware, United States
Lisa D. Levine, MD, MSCE (she/her/hers)
Associate Professor
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States