Comparing Foley Catheter to Prostaglandins for Cervical Ripening in Multiparous Women

This study sought to test the hypothesis that among multiparous women requiring cervical ripening, mechanical ripening with a Foley catheter is more effective than prostaglandin preparations.

This was a retrospective analysis of multiparous women with a singleton gestation who required cervical ripening in a single tertiary center from 2014 to 2019. Women who underwent cervical ripening with a Foley catheter (Foley group) were compared with women who underwent cervical ripening using a controlled-release dinoprostone vaginal insert (PGE₂-CR group) or dinoprostone vaginal gel (PGE₂-gel group). The primary outcome was the ripening-to-delivery interval.

A total of 229 women met the study criteria (Foley group: 95; PGE₂-CR group: 83; PGE₂-gel group: 51). Women in the Foley group had a significantly shorter ripening-to-delivery interval compared with women in the PGE₂-CR group (16.2 ± 9.2 hours vs. 27.0 ± 14.8 hours; P < 0.001) and were more likely to deliver within 12 hours (47.4% vs. 12.0%; P < 0.001; adjusted relative risk [aRR] 3.87; 95% confidence interval [CI] 2.07-7.26) and within 24 hours (78.9% vs. 49.4%; P < 0.001; aRR 1.61; 95% CI 1.26-2.06). Women in the Foley group were also less likely to require a second ripening method compared with women in the PGE₂-CR group (1.1% vs. 8.4%; P = 0.018; aRR 7.26; 95% CI 2.99-17.62). These differences were not observed when comparing the Foley and the PGE₂-gel groups. The cesarean section rate was similar among the Foley group (9.5%), PGE₂-CR group (9.6%; P = 0.970), and PGE₂-gel group (11.8%; P = 0.664).

In multiparous women requiring cervical ripening, all methods of cervical ripening have a similar success rate. However, the use of a PGE₂-CR insert is associated with a considerably longer interval to delivery compared with a Foley catheter or PGE₂ gel.