(122) Understanding the Impact of AROM with Foley placement in Terms of Vaginal Delivery

Incidental amniotomy with Foley bulb placement for cervical ripening is well described; however, its impact on the likelihood of Cesarean delivery is understudied.

Study Design:

We performed a retrospective cohort study of all pregnancies at a single institution admitted for a term ( >37 weeks) induction of labor with a Foley bulb between January 1^st, 2012, and December 31^st, 2021. They were divided into two groups: those who had incidental rupture of membranes (ROM) recorded within 60 minutes of Foley bulb placement, and those who did not. Patients whose membranes ruptured prior to Foley bulb placement were excluded.  Our primary outcome was the rate of Cesarean Delivery. Univariate analysis was performed.

Results:

A total of 8112 pregnancies met study criteria, of which 427 (5.26%) women experienced ROM with Foley bulb placement. There were no differences between the two groups in maternal race, gravidity, parity, BMI, or gestational age at time of induction. Maternal age was slightly lower in the early ROM group (28.3 versus 29.0, p = 0.03). Time spent in first or second stage of labor, or of likelihood of Cesarean section did not differ between the two groups. Neonatal death, hypoglycemia, sepsis, or respiratory assistance within 72 hours of delivery was similar between the groups.  Newborns of women who had experienced incidental amniotomy were more likely to have 1 minute APGAR less than 4 (3.28% versus 1.59%, p=0.01) as well as admission to the NICU (27.87% versus 21.42%, p = 0.002). Five minute APGAR score did not differ between the two groups.

Conclusion:

Rupture of membranes with a Foley bulb was not associated with increased likelihood of Cesarean section or increased time in labor, but was associated with higher rates of NICU admission.