Assessment of pain in women randomly allocated to speculum or digital insertion of the Foley catheter for induction of labor

Abstract

Objective: The primary aim was to assess pain subjectively and objectively in women during insertion of a Foley catheter for induction of labor. A secondary aim was to assess pain during cervical ripening and to evaluate maternal satisfaction.

Design: Randomized controlled trial.

Setting: University hospital, Sweden.

Population: Forty-two women undergoing induction of labor and cervical ripening with a Foley catheter.

Methods: Women were randomly allocated to digital (n=21) or to speculum (n=21) placement of a Foley catheter. A visual analogue scale (VAS) was used for subjective assessment of pain and, for objective measurements, a skin conductance algesimeter was used and the area under the curve (AUC) was calculated (μSs). Maternal satisfaction was evaluated in a questionnaire.

Main outcome measures: Pain sensation during placement of the Foley catheter.

Results: There was a significant difference between groups in pain measurements during insertion of the Foley catheter. The speculum group had higher median pain scores than the digital group, VAS=5 vs. = 3 (p=0.03) and greater median AUC measurements: 1840 vs. 823 μSs (p=0.04). There was no difference in pain assessments during cervical ripening. Overall satisfaction scores were high and comparable between groups.

Conclusion: Digital placement of the Foley catheter is subjectively and objectively less painful compared to the use of a speculum. Digital placement should therefore be considered as an alternative in the management of these patients. Ripening of the cervix with the Foley catheter is well tolerated and the overall satisfaction rate among patients induced with this method is high.