title: The timing of adverse events with Foley catheter preinduction cervical ripening; implications for outpatient use.
abstract: OBJECTIVE
  We sought to determine the rate and timing of adverse events that occur during preinduction cervical ripening using the Foley catheter before extrusion of the balloon and institution of oxytocin.
  
  
  METHODS
  Using electronic medical records, we identified all women who presented for preinduction cervical ripening using a Foley catheter with a term (≥37 weeks) singleton vertex live fetus from January 1, 2006, to June 14, 2009. Women were excluded if they had had a previous cesarean delivery, gestational hypertension or preeclampsia, pregestational diabetes, rupture of membranes before induction, fetal anomaly, or antepartum stillbirth. Outcomes were cesarean delivery for nonreassuring fetal tracing, vaginal bleeding, placental abruption, or intrapartum stillbirth occurring between 2 hours after Foley catheter placement and 6 am.
  
  
  RESULTS
  Among 2,514 women, 1,905 met the inclusion criteria. No adverse outcomes were noted among term, singleton uncomplicated pregnancies receiving a Foley catheter for preinduction cervical ripening who met inclusion criteria (relative risk, 0.0; 95% confidence interval, 0.0-0.002).
  
  
  CONCLUSIONS
  In a low-risk population, the use of the Foley catheter for preinduction cervical ripening was associated with no adverse outcomes. It appears to be a safe mechanism for cervical ripening and has the potential for use in the outpatient setting in a selected subset of women.
authors.affiliation: Department of Obstetrics and Gynecology, Christiana Hospital, Newark, Delaware.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Sciscione
authors.affiliation: Department of Obstetrics and Gynecology, Christiana Hospital, Newark, Delaware.
authors.forename: Casey L
authors.initials: CL
authors.lastname: Bedder
authors.affiliation: Department of Obstetrics and Gynecology, Christiana Hospital, Newark, Delaware.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Hoffman
authors.affiliation: Department of Obstetrics and Gynecology, Christiana Hospital, Newark, Delaware.
authors.forename: Kelly
authors.initials: K
authors.lastname: Ruhstaller
authors.affiliation: Department of Obstetrics and Gynecology, Christiana Hospital, Newark, Delaware.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Shlossman
mesh_terms: D000037:Abruptio Placentae / Q000209:etiology; D000328:Adult; D000553:Ambulatory Care; D057785:Catheters; D020070:Cervical Ripening; D002585:Cesarean Section; D005260:Female; D005316:Fetal Distress / Q000209:etiology / Q000601:surgery; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects* / Q000379:methods; D011247:Pregnancy; D050497:Stillbirth; D013997:Time Factors; D014592:Uterine Hemorrhage / Q000209:etiology; D055815:Young Adult