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Cervical Ripening With Transcervical Foley Catheter and the Risk of Uterine Rupture

From the Department of Obstetrics and Gynecology, Hôpital Ste-Justine, Université de Montréal, Montreal, Quebec, Canada; and the Department of Obstetrics and Gynecology, Hutzel Hospital, Wayne State University, Detroit, Michigan.

Address reprint requests to: Emmanuel Bujold, MD, Hutzel Hospital, Department of Obstetrics and Gynecology, 4707 St. Antoine Boulevard, Detroit, MI 48201; e-mail: ebujold\|[bsol ]\|{at}med.wayne.edu.

OBJECTIVE: To estimate whether the rate of uterine rupture in patients with a previous cesarean delivery is related to labor induction and/or cervical ripening using transcervical Foley catheter.

METHODS: Charts of all patients who had a trial of labor after a previous cesarean delivery in our institution between 1988 and 2002 were reviewed. The rates of successful vaginal birth after cesarean delivery and uterine rupture in patients with spontaneous labor (control group) were compared with those of patients who underwent a labor induction by means of amniotomy with or without oxytocin and patients who underwent a labor induction/cervical ripening using a transcervical Foley catheter. Logistic regression analysis was performed to adjust for confounding variables.

RESULTS: Of 2479 patients, 1807 had a spontaneous labor, 417 had labor induced by amniotomy with or without oxytocin, and 255 had labor induced by using transcervical Foley catheter. The rate of successful vaginal birth after cesarean delivery was significantly different among the groups (78.0% versus 77.9% versus 55.7%, P < .001), but not the rate of uterine rupture (1.1% versus 1.2% versus 1.6%, P = .81). After adjusting for confounding variables, the odds ratio (OR) for successful vaginal birth after cesarean delivery was 0.68 (95% confidence interval [CI] 0.41, 1.15), and the OR for uterine rupture was 0.47 (95% CI 0.06, 3.59) in patients who underwent an induction of labor using a transcervical Foley catheter when compared with patients with spontaneous labor.

CONCLUSION: Labor induction using a transcervical Foley catheter was not associated with an increased risk of uterine rupture.

LEVEL OF EVIDENCE: II-2

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