Efficiency of the Foley catheter versus the double balloon catheter during the induction of second trimester pregnancy terminations: a randomized controlled trial.

PURPOSE: To compare induction-to-delivery intervals of Foley catheters and double balloon catheters in second trimester pregnancy terminations. METHODS: This randomized parallel study was conducted on women who underwent second trimester terminations between December 2016 and December 2017. Pregnant women in the second trimester with a Bishop score < 6 were included in the study. Participants were randomized into two groups, the first being the Foley catheter group and the second being the double balloon catheter group. The time frames from insertion of catheters to the delivery were recorded in each group. A multiple regression analysis was carried out to examine the contribution of factors to the induction-to-delivery interval. A survival analysis was conducted to compare the Foley method and the double balloon method. RESULTS: A total of 91 pregnant women were included in the final analysis. The induction-to-delivery interval was shorter in the Foley catheter group than in the double balloon catheter group (38 h 54 min ± 21 h 6 min versus 58 h 17 min ± 25 h 56 min). We also found that women with intrauterine fetal death (IUFD) had a shorter time to delivery compared to women with live fetuses (39 h 12 min ± 18 h 46 min vs 51 h 30 min ± 26 h 42 min, p = 0.04). Women with a history of vaginal delivery also had a shorter induction-to-delivery time compared to women who never delivered vaginally before (38 h 12 min ± 17 h 42 min vs 53 h 54 min ± 27 h 18 min, p = 0.004). In the multiple regression analysis, the most significant contributor to the induction-to-delivery time was the method used for induction of labor and followed by other factors including the viability of the fetus (live/IUFD), history of vaginal delivery and PPROM. The survival analysis showed that the induction-to-delivery interval was significantly shorter in the Foley catheter group than in the double balloon catheter group (HR 2.51, 95% CI 1.57-4.00, p = 0.001). CONCLUSION: During the termination of second trimester pregnancies time from induction of labor to delivery is shorter with the Foley catheter compared to double balloon catheter.

The efficiency of the uterocervical angle in the prediction of second-trimester pregnancy terminations in multiparous women.

Aim: To show how uterocervical angles are used for the prediction of second-trimester pregnancy terminations in multiparous women. Material and methods: A total of 148 multiparous singleton women in their second trimesters were enrolled in this prospective study. The intracervical Foley catheter was used for the induction of delivery. The cervical length (CL) and the uterocervical angle (UCA) were measured before the beginning of induction. The study population was subdivided into four groups; successful and failed terminations at the end of 24 and 48 h time frames. A stepwise multiple regression analysis was carried out to examine the contribution of UCA and other parameters to the induction-to-delivery time. A survival analysis was conducted to compare two groups defined by the cut-off value. Results: The UCA was broader in the successful termination group compared to the failed termination group in 24 h of induction (112.50° ± 29.00° versus 100.68° ± 27.13°, p = .02). A negative correlation was found between the UCA and the induction-to-delivery time (r = -0.27, p = .0007). A cut-off value of 97.5° was found for the UCA in predicting induction outcomes. During the 24-h period, 63.1% of women with the UCA ≥97.5° terminated successfully while 36.8% of women with the UCA <97.5° terminated successfully (p = .001). The mean induction-to-delivery time was significantly shorter in the UCA ≥97.5° group compared to the UCA <97.5° group (38.2 ± 19.5 h versus 47.8 ± 27.5 h, p = .02). The binary logistic regression analysis showed that the UCA was the only contributor to a successful termination (OR = 1.01, 95% CI: 1-1.02, p = .02). Conclusion: The UCA is broader in multiparous women who successfully terminated and is linked to a shorter duration of induction. The UCA by itself is the only significant contributor to the outcome of second trimester pregnancy terminations.