Background: Due to the increased risk of
uterine rupture with prostaglandins in previous cesarean patients, its use has
been discouraged as a ripening agent in previous cesarean patients.
Alternatively, the Foley catheter has been studied as a cervical ripening agent
in previous cesarean patients. Low-dose oxytocin has also been studied as a
cervical ripening agent in women with an unscarred uterus.
Aim of the Study: The aim of the study
is to compare the efficacy and safety of Foley catheters with low-dose oxytocin
as a cervical ripening agent in women with previous cesarean section (CS).
Materials and Methods: A prospective
randomized study was conducted on 60 women (30 per group) with previous CS with
unfavorable cervix who needed induction of labor after 28 weeks. Outcomes were
analyzed in terms of change in Bishop score (BS), route of delivery and
complications. Statistical analysis was performed using Student’s unpaired
t-test, Chi-square test, and Mann — Whitney U-test.
Results: The BS before and after
ripening between the two groups was similar (P > 0.05). However, the change
in BS within each group was 3.07 and 3.30 in the Foley and oxytocin groups,
respectively, and this was statistically significant (P < 0.001). Vaginal
delivery occurred in 20 patients (66.7%) in the Foley group and 18 patients
(60%) in the oxytocin group. There were two cases of scar dehiscence in the
oxytocin group and none in the Foley group. Foley has proved to be an effective
as well as safe cervical ripening agent in patients with previous cesarean
deliveries.
Conclusion: Both Foley and low dose
oxytocin are good cervical ripening agents in previous cesarean patients.
However, the two cases of scar dehiscence in the low dose oxytocin group are a
concern of safety. Future studies should focus on large-scale, prospective
trials evaluating the safety and efficacy of Foley catheter use in women with
previous cesarean sections, specifically those meeting the eligibility criteria
outlined by ACOG.
Author (s) Details
Laishram Trinity Meetei
Departments of Obstetrics and Gynaecology, Regional
Institute of Medical Sciences, Imphal, Manipur, India.
Vanita Suri
Post Graduate Institute of Medical Education and Research, Chandigarh,
India.
Neelam Aggarwal
Post Graduate Institute of Medical Education and Research, Chandigarh,
India.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v6/5589
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