Pregnancy outcomes after failed cervical ripening with prostaglandin E2 followed by Foley balloon catheter.

OBJECTIVE

To study pregnancy outcomes of cervical ripening with Foley catheter, in women who failed to respond to prostaglandin-E2 (PGE2).

METHODS

A retrospective cohort study of all patients with a singleton pregnancy, who underwent cervical ripening with vaginal PGE2, between 2013 and 2014, was performed. Patients who failed to respond to a total dose of 6-9 mg PGE2, defined as no change in Bishop score, underwent subsequent ripening with Foley catheter (non-responders group). Data were compared to patients who achieved sufficient response to a total dose of up to 9 mg PGE2 (responders group).

RESULTS

Compared with the responders group (n = 813), patients in the non-responders group (n = 49) had higher rates of nulliparity (p < 0.001), pre-induction cervical dilation ≤1 cm (p = 0.004), pre-induction cervical effacement ≤50% (p = 0.01) and birth weight >4000 g (p = 0.02). A significantly higher cesarean delivery rate was observed in the non-responders group (51 versus 12.3%, p < 0.001). Failed ripening with PGE2 was found to be independently associated with cesarean delivery (aOR = 5.11, 95% CI = 2.72-9.62).

CONCLUSIONS

The need for an additional cervical ripening method after failure with PGE2 is associated with a very high risk of cesarean delivery. This is particularly significant in nulliparous women, women carrying large fetuses, and women presenting with a low Bishop score.