Management of Foley catheter induction among nulliparous women: a retrospective study.
BACKGROUND
Induction of labour is associated with increased risk for caesarean delivery among nulliparous women. The aims of this study were to evaluate the risk factors for caesarean delivery and to investigate the risk of maternal and neonatal infections in nulliparous women undergoing induction of labour by Foley catheter.


METHODS
This clinical retrospective study of 432 nulliparous women with singleton pregnancy and intact amniotic membranes at or beyond 37 gestational weeks scheduled for induction of labour by Foley catheter was conducted over the course of one year, between January 2012 and January 2013, in Helsinki University Hospital. The main outcome measures were caesarean section rate and maternal and neonatal infections. Univariate and multivariate logistic regressions were used to estimate relative risks by odds ratios with 95% confidence intervals.


RESULTS
The caesarean section rate was 39.1% (n = 169). In multivariate regression analysis, the factors associated with caesarean section were the need for oxytocin for labour induction [OR 2.9 (95% CI 1.8-4.5) p < 0.001] and early epidural analgesia [OR 9.9 (95% CI 2.1-47.5), p = 0.004]. The maternal intrapartum infection rate was 6.3%, and the clinical neonatal infection rate was 2.8%. In multivariate analysis, gestational diabetes was associated with maternal intrapartum infection [OR 4.3 (95% CI 1.7-11.0, p = 0.002] and early epidural analgesia with neonatal clinical sepsis [OR 10.5 (95% CI 1.4-76), p = 0.02].


CONCLUSIONS
Oxytocin induction and early epidural analgesia were associated with caesarean delivery. Gestational diabetes and early epidural analgesia were associated with infectious morbidity. Since the first caesarean delivery has a major impact on subsequent pregnancies, optimising labour induction among nulliparous women is important.
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Haartmaninkatu 2, Helsinki, 00029 HUS, Finland. heidi.kruit@hus.fi.
Heidi
H
Kruit
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Haartmaninkatu 2, Helsinki, 00029 HUS, Finland. oskari.heikinheimo@helsinki.fi.
Oskari
O
Heikinheimo
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Haartmaninkatu 2, Helsinki, 00029 HUS, Finland. veli-matti.ulander@hus.fi.
Veli-Matti
VM
Ulander
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Haartmaninkatu 2, Helsinki, 00029 HUS, Finland. ansa.aitokallio-tallberg@hus.fi.
Ansa
A
Aitokallio-Tallberg
Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland. irmeli.nupponen@hus.fi.
Irmeli
I
Nupponen
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Haartmaninkatu 2, Helsinki, 00029 HUS, Finland. jorma.paavonen@hus.fi.
Jorma
J
Paavonen
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Haartmaninkatu 2, Helsinki, 00029 HUS, Finland. leena.rahkonen@hus.fi.
Leena
L
Rahkonen
D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D016362:Analgesia, Obstetrical / Q000379:methods / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D000068104:Infant Health / Q000706:statistics & numerical data; D007231:Infant, Newborn; D007751:Labor, Induced / Q000009:adverse effects* / Q000379:methods; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology*; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000706:statistics & numerical data
D010120:Oxytocics; D010121:Oxytocin