Management of Foley catheter induction among nulliparous women: a retrospective study

BACKGROUND Induction of labour is associated with increased risk for caesarean delivery among nulliparous women. The aims of this study were to evaluate the risk factors for caesarean delivery and to investigate the risk of maternal and neonatal infections in nulliparous women undergoing induction of labour by Foley catheter. METHODS This clinical retrospective study of 432 nulliparous women with singleton pregnancy and intact amniotic membranes at or beyond 37 gestational weeks scheduled for induction of labour by Foley catheter was conducted over the course of one year, between January 2012 and January 2013, in Helsinki University Hospital. The main outcome measures were caesarean section rate and maternal and neonatal infections. Univariate and multivariate logistic regressions were used to estimate relative risks by odds ratios with 95% confidence intervals. RESULTS The caesarean section rate was 39.1% (n = 169). In multivariate regression analysis, the factors associated with caesarean section were the need for oxytocin for labour induction [OR 2.9 (95% CI 1.8-4.5) p < 0.001] and early epidural analgesia [OR 9.9 (95% CI 2.1-47.5), p = 0.004]. The maternal intrapartum infection rate was 6.3%, and the clinical neonatal infection rate was 2.8%. In multivariate analysis, gestational diabetes was associated with maternal intrapartum infection [OR 4.3 (95% CI 1.7-11.0, p = 0.002] and early epidural analgesia with neonatal clinical sepsis [OR 10.5 (95% CI 1.4-76), p = 0.02]. CONCLUSIONS Oxytocin induction and early epidural analgesia were associated with caesarean delivery. Gestational diabetes and early epidural analgesia were associated with infectious morbidity. Since the first caesarean delivery has a major impact on subsequent pregnancies, optimising labour induction among nulliparous women is important.