A randomised comparison of early versus late amniotomy following cervical ripening with a Foley catheter.
OBJECTIVE
Ripening of the cervix with a Foley catheter commonly results in cervical dilatation without contractions. We examined the outcome of labour in women who underwent induction of labour using a Foley catheter, followed by either 1. early amniotomy, or 2. augmentation of labour by oxytocin and late amniotomy.


METHODS
Prospective randomised clinical trial.


METHODS
Labour and delivery ward of a university teaching hospital.


METHODS
Pregnant women > or =38 weeks of a singleton gestation, who had had no prior caesarean section.


METHODS
All women underwent cervical ripening using a Foley catheter. Following removal of the catheter, women were randomly assigned to either early (n = 80) or late amniotomy (n = 88).


METHODS
Comparison of mode of delivery and duration of labour between the two groups.


RESULTS
The rate of caesarean section was significantly higher in the early amniotomy group compared with the late amniotomy group (25% vs 7.9%; relative risk 1.74; 95% CI 1.3 - 2.34). The increase in caesarean section rate was due primarily to dystocia (15% vs 3.3%; relative risk 1.8; 95% CI 1.32 - 2.45). When excluding caesarean deliveries, no significant difference was found in duration of labour between the groups (8.3 hours (3.8) vs 7.7 hours (2.9)).


CONCLUSIONS
In women who undergo cervical ripening with a Foley catheter, augmentation of labour by oxytocin followed by amniotomy during active labour results in a lower rate of caesarean delivery for dystocia.
Levy
Roni
R
Department of Obstetrics and Gynaecology, Kaplan Medical Centre, Rehovot Hebrew University Medical School, Jerusalem, Israel.
Ferber
Asaf
A
Ben-Arie
Alon
A
Paz
Beatrice
B
Hazan
Ynon
Y
Blickstein
Isaac
I
Hagay
Zion J
ZJ
D000328:Adult; D000650:Amnion / Q000601:surgery*; D002404:Catheterization / Q000379:methods*; D020070:Cervical Ripening; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007744:Obstetric Labor Complications / Q000628:therapy*; D010121:Oxytocin / Q000008:administration & dosage; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013997:Time Factors; D014590:Uterine Contraction
D010121:Oxytocin