44 - Six vs. Twelve Hours of Foley Catheter Placement for Induction: A Randomized Controlled Trial
Friday, January 29, 2021
3:30 PM – 3:45 PM EST
Objective: To evaluate whether time to delivery is shorter for women who undergo an induction with cook catheter and oxytocin for six as compared to twelve hours
Study Design: In this randomized controlled trial, labor induction was performed using combination cook catheter and oxytocin. Term women aged 18-50 years old with vertex singletons were included if they were undergoing induction of labor with a Bishop score less than 6 and dilation less than 2cm. Women were randomized to planned removal of the cook catheter at six or twelve hours. Primary outcome was insertion-to-delivery time. We were powered to detect a 4-hour difference with a sample size of 89 women per group (n=178). Planned sensitivity analyses were performed (a) excluding cesarean deliveries and (b) using Cox Proportional Hazards models censoring for cesarean delivery in labor.
Results: From February 2019-June 2020 237 women were screened and 178 were randomized 1:1. One person in the twelve-hour group was excluded because her induction was interrupted. Women were similar with regards to baseline characteristics including parity (71% nulliparous in six-hour group and 68% in the twelve-hour group; p=). Insertion-to-delivery time was significantly shorter in the six-hour group (19.2 vs. 24.3 hours, p=0.04) and the proportion of women delivered by 24 hours was significantly greater in the six-hour group (67% vs. 47%, p<0.01). There was no difference in Bishop score at removal. In the Cox Proportional Hazard Model, the six-hour group had a significantly shorter time to delivery (HR 0.67, p=0.02). (Figure 1). There were no differences in cesarean delivery rates (19% vs. 28%, p=0.15) nor any differences in other maternal or neonatal outcomes, including infection rates.
Conclusion: Labor induction with a cook catheter and oxytocin with planned removal at 6 hours, rather than 12 hours, results in shorter time to delivery. Decreasing the planned length of time a cook catheter is in place should be considered in clinical protocols.