Labor Length Differences in Combination Ripening with 60 versus 30-mL Foley Inflation Volume: A Propensity...

Data support shorter time to delivery with 60 versus 30-mL Foley inflation for labor induction. Similarly, combination cervical ripening has a shorter time to delivery compared with single agents. To date, no study has evaluated incremental benefit of higher Foley volume in the setting of combination ripening methods.This is a secondary analysis of a prospective cohort study evaluating standardized induction management at two sites. Any cervical ripening method could be used. Site no. 1 used 60-mL Foley inflation, whereas Site no. 2 used 30 mL. For this analysis, patients were included if they underwent a term (≥37 weeks) induction from 2020 to 2022 with a singleton, intact membranes, and received combination methods of Foley and another agent. A 1:1 propensity score matching balanced baseline parameters.Of 4,295 inductions, 2,117 (49.3%) utilized combination cervical ripening methods. After propensity score matching, 1,480 were included. Even in the context of combined ripening and standardized induction, Foley inflation to 60 mL was associated with a 3-hour shorter labor length than 30 mL (14.6 [10.4-21.3] vs. 17.7 hours [12.4-24.4], p < 0.001). When censored for cesarean, patients who received 60-mL Foley inflation delivered 70% faster than those who received 30 mL (hazard ratio: 1.73 [1.36-2.21]). There was no difference in cesarean, maternal morbidity, or neonatal morbidity.Even when using combined cervical ripening methods, 60-mL Foley inflation is associated with reduced time to delivery as compared with 30 mL without increasing morbidity. · No prior study has evaluated incremental benefit of higher Foley volume.. · Combined cervical ripening with 60-mL Foley is associated with reduced time to delivery.. · Combined cervical ripening with 60-mL Foley is not associated with differences in morbidity..