The Effect Of Foley Catheter Combined With Vaginal Prostaglandin E2 For Induction Cervical Ripening In Pregnant Women With Bishop Low-score Cervical Conditions:a Retrospective Cohort Study

Objective: Induction of labor in late pregnancy is the process through drugs and other means by which uterine contractions are stimulated before the onset of spontaneous labor,to achieve the purpose of delivery.The key to the success of labor induction lies in the ripeness of the cervix and the choice of labor induction methods.The less mature the cervix,the lower the success rate of labor induction.If the cervix is immature,it must be promoted first.Cervical ripening methods include both mechanical(e.g.,the Foley catheter balloon is placed in the cervix for 12 to 24 hours,etc.)and pharmacological methods(e.g.,intravenous infusion of small doses of oxytocin,misoprostol and dinoprostone suppositories in the posterior fornix of the vagina,etc.).Studies have pointed out that the combination of drugs and mechanical methods has a synergistic effect.There are more studies on the effectiveness of Foley catheter combined with misoprostol to induce cervical ripening,and few studies on Foley catheter combined with prostaglandin E2(PGE2)to promote cervical ripening.The purpose of this study is to retrospectively analyze the effect of Foley catheter combined with PGE2 for induction cervical ripening in full-term pregnant women with Bishop low-score cervical conditions,and to confirm that,for pregnant women with low Bishop cervical score,preconditioning with Foley catheter to improve cervical Bishop score is helpful for induction of labor.Methods:1.Subjects: This was a retrospective cohort study of full-term pregnant women undergoing labor induction with use of Foley catheter combined with PGE2 and PGE2 for cervical ripening between January 2016 and May 2020 at the obstetrics department of the East Branch of the Fourth Hospital of Hebei Medical University.According to the inclusion and exclusion criteria,there were 107 full-term pregnant women with cervical ripening and labor induction.2.Groups: 48 pregnant women used Foley catheter combined with PGE2 to promote cervical ripening and labor(Foley + PGE2 group)and Bishop score before labor induction: 2.00(1.00～2.00),59 pregnant women used PGE2 alone to promote cervical ripening and induction of labor(PGE2 group)and Bishop score before labor induction: 3.00(2.00～4.00).3.Research contents: The rate of cesarean section,the time from PGE2 to labor and delivery,adverse reactions to labor induction,maternal and infant delivery outcomes were analyzed to evaluate the labor induction effect of Foley catheter combined with PGE2 promoting cervical maturation in the two groups.Results:1.There was a statistically significant difference in cervical Bishop scores between the two groups before labor induction(P=0.000),the Foley+PGE2 group had poorer cervical conditions,and there was no statistically significant difference in the cesarean section rate between the two groups of pregnant women(50.0% VS 52.5%,P=0.794).2.There was no statistically significant difference in the time between PGE2 use to regular uterine contraction,PGE2 use to delivery time,PGE2 duration,and vaginal delivery time of each labor process(P=0.208,P=0.557,P=0.941,P=0.833,P=0.199,P=0.402,P=0.911).In the Foley+PGE2group,the time from PGE2 to regular uterine contraction was shortened by an average of about 2 hours(4.09(1.94-15.07)h VS 6.33(3.02-24.82)h),and the time from PGE2 to delivery was shortened byabout 7 hours(16.04(11.37～28.90)h VS 23.85(9.72～32.30)h)on average.3.Groups were found to be similar in adverse reactions(P=0.783),the mother’s delivery outcome(vaginal delivery P=0.494,blood loss 2 hours after delivery P=0.243,no infection and perineal laceration ≥ Ⅲ degree occurred in the two groups of pregnant women)and neonatal outcome(newborn birth weight P=0.490,Apgar score 1 min P=0.688,Apgar score 5 min P=1.000).Conclusions: For full-term pregnant women with low cervical scores,Foley catheter combined with PGE2 is used to promote cervical ripening and induction of labor: 1.It shortens the time from dinoprostone suppository to labor and delivery,2.It does not increase the rate of cesarean section and the mother The risk of adverse infant outcomes.