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Does Cervical Ripening With Foley Catheters Increase Infectious Morbidity? A Systematic Review With Meta-analysis [36]

OBJECTIVE: To evaluate any association of Foley balloon catheter use for cervical ripening with infectious morbidity. DATA SOURCES: The literature search was performed using computerized databases, references in published studies, and textbook chapters without language restriction. Searches were performed in MEDLINE, PubMed, ClinicalTrials.gov, Web of Science, and the Cochrane Library through December 2014. Medical subject headings used included the terms “Foley catheter,” “Foley balloon” “prostaglandin,” “labor induction,” and “cervical ripening.” METHODS OF STUDY SELECTION: We identified randomized controlled trials that compared Foley balloon catheter with locally applied prostaglandin preparations for cervical ripening or labor induction. Selected studies evaluated maternal or neonatal infection with at least one of the following outcomes: chorioamnionitis, endometritis, pooled maternal infection, and neonatal infection. Excluded studies utilized double-balloon catheters, outpatient Foley management, extra-amniotic saline infusions, first or second trimester pregnancy termination, and oral administration of medication in the prostaglandin arm. TABULATION, INTEGRATION, AND RESULTS: Twenty-six randomized trials including 5,563 women were identified. Compared with prostaglandin preparations alone, patients who underwent cervical ripening with a Foley balloon catheter had similar rates of chorioamnionitis (relative risk [RR] 0.96; 95% CI 0.66, 1.38), endometritis (RR 1.02, 95% CI 0.66, 1.6), pooled maternal infection (RR 0.95, 95% CI 0.81, 1.12), and neonatal infection (RR 0.89, 95% CI 0.58, 1.39). With subgroup analysis, excluding studies in which the cervix was pre-cleansed with antiseptic solution or prophylactic antibiotics were administered, the results were similar: chorioamnionitis (RR 0.95, 95% CI 0.65, 1.39), endometritis (RR 1.03, 95% CI 0.65, 1.64), pooled maternal infection (RR 1.05, 95% CI 0.87, 1.27), and neonatal infection (RR 1.09, 95% CI 0.54, 2.24). CONCLUSION: Use of transcervical Foley balloon catheters for cervical ripening and induction of labor is not associated with an increased risk of infectious morbidity.