Abstract
ABSTRACTObjectiveTo evaluate the rate of preterm birth (PTB) in a subsequent pregnancy in women who had undergone term induction using a Foley catheter compared with prostaglandins.MethodsThis was a follow‐up study of two large randomized controlled trials (PROBAAT‐1 and PROBAAT‐2). In the original trials, women with a term singleton pregnancy with the fetus in cephalic presentation and with an indication for labor induction were randomized to receive either a 30‐mL Foley catheter or prostaglandins (vaginal prostaglandin E2 in PROBAAT‐1 and oral misoprostol in PROBAAT‐2). Data on subsequent ongoing pregnancies > 16 weeks’ gestation were collected from hospital charts from clinics participating in this follow‐up study. The main outcome measure was preterm birth < 37 weeks’ gestation in a subsequent pregnancy.ResultsFourteen hospitals agreed to participate in this follow‐up study. Of the 1142 eligible women, 572 had been allocated to induction of labor using a Foley catheter and 570 to induction of labor using prostaglandins. Of these, 162 (14%) were lost to follow‐up. In total, 251 and 258 women had a known subsequent pregnancy > 16 weeks' gestation in the Foley catheter and prostaglandin groups, respectively. There were no differences in baseline characteristics between the groups. The overall rate of PTB in a subsequent pregnancy was 9/251 (3.6%) in the Foley catheter group vs 10/258 (3.9%) in the prostaglandin group (relative risk (RR), 0.93; 95% CI, 0.38–2.24), and the rate of spontaneous PTB was 5/251 (2.0%) vs 5/258 (1.9%) (RR, 1.03; 95% CI, 0.30–3.51).ConclusionIn women with term singleton pregnancy, induction of labor using a 30‐mL Foley catheter is not associated with an increased risk of PTB in a subsequent pregnancy, as compared to induction of labor using prostaglandins. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Highlights
Labor induction is a common obstetric procedure, which is generally carried out when the risk of continuing pregnancy outweighs the benefit
The overall rate of preterm birth (PTB) in a subsequent pregnancy was 9/251 (3.6%) in the Foley catheter group vs 10/258 (3.9%) in the prostaglandin group (relative risk (RR), 0.93; 95% CI, 0.38–2.24), and the rate of spontaneous
It is unknown whether a balloon catheter for labor induction has a similar traumatizing effect on cervical integrity, which could lead to spontaneous PTB in a subsequent pregnancy
Summary
Labor induction is a common obstetric procedure, which is generally carried out when the risk of continuing pregnancy outweighs the benefit. Either congenital or as a result of trauma, are a risk factor for structural cervical weakness, which can lead to PTB. Known traumas associated with spontaneous PTB are mechanical cervical dilation during a gynecologic procedure and treatment of cervical intraepithelial neoplasia[5,6]. It is unknown whether a balloon catheter for labor induction has a similar traumatizing effect on cervical integrity, which could lead to spontaneous PTB in a subsequent pregnancy. Studies examining the association between induction of labor using a balloon catheter and subsequent PTB are few and provide low-quality evidence, and no data from randomized controlled trials (RCTs) are available to answer the question of whether a balloon catheter increases the risk of PTB in a subsequent pregnancy[7,8,9]
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