Traction versus no traction in Foley catheter use for induction of labor: a systematic review and meta-analysis of randomized trials

Author Department

Ob/Gyn

Document Type

Article, Peer-reviewed

Publication Date

3-2022

Abstract

Objective: Intracervical Foley catheter is a safe and effective method for cervical ripening. There are a variety of ways to modify this ripening method, including adding traction or tension to the catheter. The utility of this practice is uncertain. The aim of this systematic review and meta-analysis of randomized controlled trials was to investigate whether the placement of traction vs no traction on a Foley catheter during cervical ripening decreases total time from induction to delivery.

Data sources: Electronic sources include MEDLINE, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, Scielo, the Cochrane Central Register of Controlled Trials, and Google Scholar from inception through June 2020.

Study eligibility criteria: Randomized trials comparing Foley catheter with traction (i.e. intervention) versus Foley catheter without traction (i.e. control) for cervical ripening were included in the meta-analysis. All types of traction were analyzed (weighted, taped to thigh) and whether the traction was placed only initially at Foley catheter placement or repeated throughout the ripening process.

Study appraisal and synthesis methods: The primary outcome was the mean time from induction to delivery in hours. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) with 95% confidence interval (CI). Heterogeneity was measured using I-squared (Higgins I2).

Results: Three trials including 790 singleton gestations were identified as relevant and included in the systematic review. Women randomized to traction on Foley balloon had a similar time from induction to delivery, compared to no traction (MD 0.25, CI -0.78 to 1.27). No significant differences were found in the secondary outcomes. There was no difference in cesarean delivery between groups (RR 0.94, 95% CI 0.74 to 1.19). Foley catheter expulsion was faster in the tension group (MD -3.74, 95% CI -6.29 to -1.19) Conclusion: Adding traction to an intracervical Foley catheter during cervical ripening does not decrease time to delivery.

Keywords: Foley catheter; balloon; cervical ripening; labor induction; tension; traction; weight.

PMID

35257939

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