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

Corina N Schoen; Gabriele Saccone; Vincenzo Berghella; Elizabeth G Baker

doi:10.1016/j.ajogmf.2022.100610

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

Am J Obstet Gynecol MFM. 2022 Jul;4(4):100610. doi: 10.1016/j.ajogmf.2022.100610. Epub 2022 Mar 4.

Authors

Corina N Schoen¹, Gabriele Saccone², Vincenzo Berghella³, Elizabeth G Baker⁴

Affiliations

¹ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UMASS Chan School of Medicine - Baystate Medical Center, Springfield, MA (Drs Schoen and Baker). Electronic address: Corina.SchoenMD@baystatehealth.org.
² School of Medicine, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (Dr Saccone).
³ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (Dr Berghella).
⁴ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UMASS Chan School of Medicine - Baystate Medical Center, Springfield, MA (Drs Schoen and Baker).

PMID: 35257939
DOI: 10.1016/j.ajogmf.2022.100610

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 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 (ie, intervention) vs Foley catheter without traction (ie, 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.

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 with 95% confidence interval. 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 the Foley balloon had a similar time from induction to delivery compared with no traction (mean difference, 0.25; confidence interval, -0.78 to 1.27). No significant differences were found in the secondary outcomes. There was no difference in cesarean delivery between groups (relative risk, 0.94; 95% confidence interval, 0.74-1.19). Foley catheter expulsion was faster in the tension group (mean difference, -3.74; 95% confidence interval, -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.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Catheters
Female
Humans
Labor, Induced / methods
Oxytocics*
Pregnancy
Randomized Controlled Trials as Topic
Traction

Substances

Oxytocics