Foley Catheter for Cervical Ripening Across Gestational Ages: A Retrospective Descriptive Study in a Resource-Limited...

Induction of labor or pregnancy termination is a frequent obstetric intervention when continuation of pregnancy may endanger maternal or fetal health. Mechanical cervical ripening using a Foley catheter has regained clinical interest due to its favorable safety profile, low cost, and ease of use. Compared with pharmacologic agents, it is associated with a lower risk of uterine hyperstimulation while facilitating cervical ripening. This study aimed to describe the safety, feasibility, and outcomes of Foley catheter use across the three gestational trimesters in a single institution during a period when prostaglandins were temporarily unavailable. A retrospective descriptive study was conducted at Mohammed VI University Hospital, Marrakesh, Morocco, from October 2024 to February 2025, including 104 patients: 37 in the first trimester (T1), 14 in the second trimester (T2), and 53 in the third trimester (T3). A 16-18-Fr Foley catheter inflated with 50-60 mL saline was used for cervical ripening. In T3, oxytocin infusion was administered after catheter expulsion or removal, whereas in T1 and T2, the catheter was used as the sole induction method. Evaluated endpoints included induction time intervals, success rates, maternal morbidity, and neonatal outcomes.  Among all patients, 72.1% initiated labor within 12 hours of catheter insertion. The mean induction-to-expulsion/delivery interval was 17.5±7.2 hours in T1, 16.8±6.8 hours in T2, and 12.2±5.4 hours in T3. Induction success rates were 100% in T1 and T2 and 94.3% (50/53) in T3. Morbidity was low, with no maternal deaths reported. In T3, among live births, 77.1% of neonates had an Apgar score of ≥8 at five minutes, reflecting an overall favorable neonatal condition in this group. Foley catheter mechanical induction appears to be a feasible and safe strategy across all gestational trimesters, particularly in resource-limited settings.