Laird Harrison

May 04, 2015

SAN FRANCISCO — When labor is induced with a Foley catheter balloon, women deliver, on average, 10 hours sooner than when it is induced with a Cook Cervical Ripening Balloon, a new retrospective study shows.

In addition, hospital stays were shorter when women were induced with the inexpensive Foley catheter balloon, and there was less chorioamnionitis and a trend toward fewer cesarean deliveries, said Jenelle Robinson, MD, from the Icahn School of Medicine at Mount Sinai, Queens Hospital Center, in Jamaica, New York.

"The old-school way is better," she told Medscape Medical News.

Dr Robinson presented the study results here at the American Congress of Obstetricians and Gynecologists Annual Clinical Meeting 2015.

Mechanical devices to induce labor date back to ancient times, she explained, and generations of obstetricians have used balloons. The Foley catheter balloon, designed to drain the bladder, has been among the most commonly used devices.

The Cook device, which was specifically designed to induce labor, became available more recently.

When Dr Robinson, who is a fourth-year resident, was in her second year, "the hospital started using the Cook," and she asked herself, "Why are we doing this?"

To see which device produced better results, Dr Robinson and her colleagues retrospectively reviewed the charts of 172 women induced at Queens Hospital Center in 2013.

The old-school way is better.

Women with singleton pregnancies and cephalic presentation, intact amniotic membranes at term, an estimated gestation of more than 37 weeks, and cervixes not effaced or dilated were included in the analysis.

In the final cohort of 165 women who met the inclusion criteria, 27 women were induced with the Foley catheter and 138 were induced with the Cook device. Some of the women received prostaglandins prior to mechanical induction.

The differences between the Foley and Cook groups were not significant for mothers' age, body mass index, gestational age, parity, racial and ethnic background, or Bishop score.

The women in the Foley group fared better than those in the Cook group on every outcome measure studied. In addition, the Foley catheter is less expensive, Dr Robinson said.

Table. Outcomes With the Two Devices

Outcome Foley Device Cook Device P Value
Time to delivery, min 1069 1700 .0001
Cesarean delivery, % 18 37 .077
Hospital stay >4 days, % 48 81 .001
Chorioamnionitis, % 7 25 .025
Cost, $ 3 41


The study "shows that you can use an inexpensive device rather than one that's specifically designed" to induce labor, said Benita Gross, MD, from the Albert Einstein College of Medicine in Bronx, New York.

But the results could vary with technique, Dr Gross pointed out. "I don't think anyone has tried putting a weight on the end of a Cook catheter," she told Medscape Medical News.

Dr Gross and Dr Robinson have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting 2015: Abstract 96. Presented May 3, 2015.


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