Induction of Labor Using a Foley Balloon, With and Without Extra-Amniotic Saline Infusionстатья из журнала
Аннотация: For the purpose of promoting ripening of the cervix to induce labor, use of a Foley bulb has in several studies proved to be at least as effective as other mechanical as well as pharmacologic methods and has not increased maternal or fetal morbidity. Placement of a bulb sometimes is combined with infusion of extraamniotic saline through the catheter at a rate of 30 to 40 mL/hour. Conceivably, the infusion promotes the release of prostaglandin, which in turn shortens labor. There is a theoretical risk, however, that vaginal flora might contaminate the choriodecidual space and produce chorioamnionitis. This study evaluated both measures in 140 women presenting for induction of labor with a Bishop score less than 5. All were 18 years of age or older and had a singleton pregnancy at or beyond 34 completed weeks of gestation. In addition, participants had a cephalic presentation, intact membranes, and a reassuring fetal heart tracing. All of the women had a 30-F Foley catheter inserted through the cervix (outside the chorioamnion) into the lower uterine segment. The bulb was inflated with 50 mL of sterile water before starting an oxytocin infusion. The Foley was left in place for 12 hours unless the membranes ruptured. Sixty-six of the 140 women had normal saline infused through the catheter at a rate of 40 mL/hour using an intravenous infusion pump until the catheter was removed or expelled. The 2 treatment groups were similar demographically. The average time from induction to vaginal delivery was significantly shorter in women given the extraamniotic saline infusion, but rates of cesarean delivery did not differ. Median 1- and 5-minute Apgar scores were comparable in the 2 groups. Fewer women having saline infused developed chorioamnionitis, but the difference (16% vs 6%) was not significant. Four women with adverse events (2 emergent operative deliveries, and one case each of neonatal sepsis and postpartum sepsis, the latter resulting in adult respiratory distress syndrome) all were in the Foley group. Three of 5 women with postpartum bleeding had received a saline infusion. The investigators strongly recommend that, for women presenting with an unfavorable cervix, saline should be infused extraamniotically through a transcervical catheter as an aid to inducing labor. The resulting interval from induction to vaginal delivery is shorter than when a Foley is inserted without infusing saline.
Год издания: 2006
Авторы: Nicole W. Karjane, Ellen L. Brock, Scott W. Walsh
Издательство: Lippincott Williams & Wilkins
Источник: Obstetrical & Gynecological Survey
Ключевые слова: Maternal and Perinatal Health Interventions, Assisted Reproductive Technology and Twin Pregnancy, Maternal and fetal healthcare
Открытый доступ: closed
Том: 61
Выпуск: 7
Страницы: 431–432