A review of maternal and fetal outcome of induction of labour with Foley’s catheter and extra amniotic saline infusion in women with previous caesarean delivery


  • Sunil Kumar Department of Obstetrics and Gynecology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
  • Nishtha A. Mahabalshetti Department of Obstetrics and Gynecology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
  • Dinu Simon Dinu Simon Department of Obstetrics and Gynecology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India




Extra amniotic saline infusion, Foley’s catheter, Induction of labour, Previous LSCS


Background: Incidence of induction of labour has increased in the recent past due to increased screening facilities like ante partum fetal surveillance. Vaginal birth after caesarean section (VBAC) is one of the strategies developed to control the rising rate of caesarean sections. Intracervical Foley’s catheter reduces the risk of uterus hyper tonicity and rupture in women with one caesarean section as it’s placement induces the cervical repining without inducing any uterine contractions.

Methods: A prospective study of 35 women with one previous LCSs, term gestation and singleton pregnancy, were selected for trial of labour (TOL) considering inclusion and exclusion criteria.

Results: Out of 35 cases studied 21 cases (60%) went for successful induction with Foleys and the remaining 40% underwent caesarean section. The mean time interval for Foley’s expulsion was 6.74 in the success group and 10.04 in the failed group (p value <0.05). In 4 cases there were meconium stained liquor, and they underwent emergency LSCS. One case (2.8%) had scar rupture which also underwent caesarean section.

Conclusions: This study shows that the Foley catheter is an effective method of cervical ripening with additional benefit of low cost, reversibility, easy availability and lack of need for special storage. This method confers significant improvement in Bishop Score and vaginal delivery was achieved in majority of patients.


Mishra R. Management of labour. Renu Mishra. Ian Donald‟s, Practical obstetric problems. 7th ed. BI publications: New Delhi; 2014:584.

Jozwiak M, Rengerink KO, Ten Eikelder ML, van Pampus MG, Dijksterhuis MG, de Graaf IM et al. Foley catheter or prostaglandin E2 inserts for induction of labour at term: an open-label randomized controlled trial (PROBAAT-P trial) and systematic review of literature. Eur J Obstet Gynecol Reprod Biol. 2013 Sep;170(1):137-45.

Ledingham MA, Denison FC, Kelly RW, Young A, Norman JE. Nitric oxide donors stimulate prostaglandin F2α and inhibit thromboxane B2 production in the human cervix during the first trimester of pregnancy. Molecular Human Reproduction. 1999 Oct;5(10):973-82.

Shi L, Shi SQ, Saade GR, Chwalisz K, Garfield RE. Studies of cervical ripening in pregnant rats: effects of various treatments. Molecular Human Reprod. 2000 Apr;6(4):382-9.

American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No.342: induction of labour for vaginal birth after caesarean delivery. Obstet Gynecol. 2006 Aug;108(2):465-8.

Gary CF. Willams Obstetrics. 24th ed. New York: McGraw Hill; 2014:523.

Sherman DJ, Frenkel E, Pansky M, Caspi E, Bukovsky I, Langer R. Balloon cervical ripening with extra‐amniotic infusion of saline or prostaglandin E2: a double‐blind, randomized controlled study. Obstet Gynecol. 2001 Mar;97(3):375-80.

Heinemann J, Gillen G, Sanchez-Ramos L, Kaunitz AM. Do mechanical methods of cervical ripening increase infectious morbidity? A systematic review. Am J Obstet Gynecol. 2008 Aug 1;199(2):177-88.

Cromi A, Ghezzi F, Uccella S, Agosti M, Serati M, Marchitelli G et al. A randomized trial of preinduction cervical ripening: dinoprostone vaginal nsert versus double-balloon catheter. Am J Obstet Gynecol. 2012 Aug;207(2):125-e1.

Jozwiak M, Rengerink KO, Benthem M, van Beek E, Dijksterhuis MG, de Graaf IM, et al. Foley catheter versus vaginal prostaglandin E2 gel for induction of labour at term (PROBAAT trial): an open-label, randomised controlled trial. Lancet. 2011 Dec 17;378(9809):2095-103.

Agnew G, Turner MJ. Vaginal prostaglandin gel to induce labour in women with one previous caesarean section. J Obstetric Gynaecol. 2009 Jan;29(3):209-11.

Nooh A. Is it worth inducing labour in women with a previous caesarean delivery. J Obstet Gynaecol. 2012 Feb;32(2):141-4.

Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean birth. Green-top guideline. 2007(45).

Kausar, S, Ali R. A comparison of effectiveness of hydrostatic membrane sweeping with intracervical Foley catheter ballooning alone in pre induction cervical ripening. APMC. 2012 Jan;6(1):51-5.

Rezk M, Sanad Z, Dawood R, Masood A, Emarh M, Al Halaby A. intracervical foley catheter versus vaginal isosorbid mononitrate for induction of labor in women with previous one cesarean section. J Clin Gynecol Obstet. 2014 May;3(2):55-61.

Karjane NW, Brock EL, Walsh SW. Induction of labor using a foley balloon, with and without extra-amniotic saline infusion. Obstet Gynecol. 2006 Feb;107(2, Part 1):234-9.

Guinn DA, Goepfert AR, Christine M, Owen J, Hauth JC. Extra-amniotic saline, laminaria, or prostaglandin E 2 gel for labor induction with unfavorable cervix: a randomized controlled trial. Obstet Gynecol. 2000 Jul 31;96(1):106-12.

Goldman JB, Wigton TR. A randomized comparison of extra amniotic saline infusion and intra cervical dinoprostone gel for cervical ripening. Obstet Gynecol. 1999;93:271-4.

Rouben D, Arias F. A randomized trial of extra-amnioticsaline infusion plus intracervical Foley catheter balloon versus prostaglandin E2 vaginal gel for ripening the cervix and inducing labor in patient with unfavorable cervixes. Obstet Gynecol.1993;82:290-4.






Original Research Articles