Predictors of cesarean delivery in women undergoing labor induction with a Foley balloon

Abstract

Objective: To examine predictive characteristics for cesarean delivery (CD) in women undergoing labor induction with a Foley balloon (FB).

Methods: A secondary analysis of a randomized, double-blind, control trial examining labor induction with a transcervical 30 mL or 60 mL FB. One-hundred ninety-nine women with term, vertex, singleton pregnancies and Bishop score < 5 were randomized to receive a transcervical 30 mL or 60 mL FB. Mode of delivery, labor complications and neonatal outcomes were recorded. A multivariable model was performed to determine predictive characteristics for CD.

Results: Increasing maternal age (p = 0.04), nulliparity (p =0.002) and chorioamnionitis (p < 0.001) were significantly associated with an elevated risk for CD. Nulliparity was associated in an almost 4-fold increased CD risk (relative risk [RR]: 3.88; 95% confidence interval [CI]: 1.22-12.3). Women aged ≥ 40 years, had an almost 3-fold increased risk of CD as compared to women aged 20-29 (RR: 2.91; 95% CI: 1.36-6.19) years. Chorioamnionitis was associated with nearly a 2-fold increased risk for CD (RR: 1.87; 95% CI: 1.06-3.32). A gestational age of ≥ 41 weeks, prostaglandin use during induction and induction indication did not affect mode of delivery.

Conclusion: In patients undergoing labor induction with a FB, increasing maternal age, nulliparity and chorioamnionitis are associated with an elevated risk for CD.

Keywords: Bishop score; Foley catheter; cesarean delivery; labor induction; nulliparous.