title: Pregnancy outcomes after failed cervical ripening with prostaglandin E2 followed by Foley balloon catheter.
abstract: To study pregnancy outcomes of cervical ripening with Foley catheter, in women who failed to respond to prostaglandin-E2 (PGE2).
  
  
  
  A retrospective cohort study of all patients with a singleton pregnancy, who underwent cervical ripening with vaginal PGE2, between 2013 and 2014, was performed. Patients who failed to respond to a total dose of 6-9 mg PGE2, defined as no change in Bishop score, underwent subsequent ripening with Foley catheter (non-responders group). Data were compared to patients who achieved sufficient response to a total dose of up to 9 mg PGE2 (responders group).
  
  
  
  Compared with the responders group (n = 813), patients in the non-responders group (n = 49) had higher rates of nulliparity (p < 0.001), pre-induction cervical dilation ≤1 cm (p = 0.004), pre-induction cervical effacement ≤50% (p = 0.01) and birth weight >4000 g (p = 0.02). A significantly higher cesarean delivery rate was observed in the non-responders group (51 versus 12.3%, p < 0.001). Failed ripening with PGE2 was found to be independently associated with cesarean delivery (aOR = 5.11, 95% CI = 2.72-9.62).
  
  
  
  The need for an additional cervical ripening method after failure with PGE2 is associated with a very high risk of cesarean delivery. This is particularly significant in nulliparous women, women carrying large fetuses, and women presenting with a low Bishop score.
authors.affiliation: a Department of Obstetrics & Gynecology , Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University , Holon , Israel.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Mizrachi
authors.affiliation: a Department of Obstetrics & Gynecology , Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University , Holon , Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Levy
authors.affiliation: a Department of Obstetrics & Gynecology , Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University , Holon , Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Weiner
authors.affiliation: a Department of Obstetrics & Gynecology , Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University , Holon , Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar
authors.affiliation: a Department of Obstetrics & Gynecology , Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University , Holon , Israel.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barda
authors.affiliation: a Department of Obstetrics & Gynecology , Edith Wolfson Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University , Holon , Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Kovo
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D001724:Birth Weight; D002404:Catheterization / Q000379:methods*; D020070:Cervical Ripening / Q000187:drug effects*; D002585:Cesarean Section; D015232:Dinoprostone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods*; D016015:Logistic Models; D010120:Oxytocics / Q000008:administration & dosage*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012044:Regression Analysis; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D010120:Oxytocics; D015232:Dinoprostone
keywords: Cervical ripening; Foley catheter; labor induction; prostaglandins