Use of intracervical Foley catheter for pre-induction cervical ripening in women planned for vaginal birth after previous caesarean section


  • Sheenam Jakhar Department of Obstetrics and Gynaecology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia hospital, New Delhi, India
  • Veena Ganju Malla Department of Obstetrics and Gynaecology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia hospital, New Delhi, India



Bishop score, Elective repeat caesarean delivery, Induction of labour, Trial of labour after caesarean, Vaginal birth after caesarean section


Background: Vaginal birth after previous caesarean section is challenging for obstetricians due to increased risk of uterine rupture. Common methods for labour induction in post caesarean pregnancies are membrane sweeping, balloon catheters, prostaglandins (PGE2), and oxytocin. As currently available data is limited, the evidence of safest method of induction is lacking. The present study aimed to assess the effectiveness of intra-cervical Foley catheter for pre-induction cervical ripening in women planned for vaginal birth after caesarean section.

Methods: This prospective cross-sectional study included 24 pregnant women with a history of previous caesarean section, admitted for induction of labour. Induction was performed in patients with unfavourable modified Bishop Score by intra-cervical Foley catheter. The change in modified Bishop Score, oxytocin requirement, induction-delivery interval, mode of delivery, maternal complications and neonatal outcome were observed.

Results: There was significant improvement in modified BS noted at the end of trans-cervical Foley catheter induction and this improvement in mean of modified BS was observed to be statistically significant (p<0.0001). The vaginal delivery rate was 29.2% while 70.8% of patients underwent caesarean section. No significant maternal or foetal complications were observed with Foley catheter induction except for one case of vaginal bleeding. There was no case of intrapartum or postpartum maternal infection.

Conclusions: Foley catheter may be a cheap and effective method for pre-induction cervical ripening and induction of labour in patients with previous caesarean section.


Radhakrishnan T, Vasanthakumari KP, Babu PK. Increasing trend of caesarean rates in India: evidence from NFHS-4. J Med Sci Clin Res. 2017;5(8):26167-76.

Stanton CK, Holtz SA. Levels and trends in cesarean birth in the developing world. Stud Fam Plan. 2006;37(1):41-8.

HKCOG Territory-wide O and G Audit Report: Caesarean section. Hong Kong: Hong Kong College of Obstetricians and Gynaecologists; 2009. Available at:

Birth after previous Caesarean birth. RCOG Green-top Guideline No. 45. Royal College of Obstetricians and Gynaecologists; 2007.

American College of Obstetrics and Gynaecologists. Vaginal birth after caesarean delivery. ACOG Practice bulletin no. 115. Obstet Gynecol. 2010;116:450-63 .

Talaulikar VS, Arulkumaran S. Failed induction of labor: strategies to improve the success rates. Obstet Gynecol Survey. 2011;66(11):717-28.

Kaczmarczyk M, Sparen P, Terry P, Cnattingius S. Risk factors for uterine rupture and neonatal consequences of uterine rupture: a population-based study of successive pregnancies in Sweden. BJOG. 2007;114(10):1208-14.

Kelly AJ, Malik S, Smith L, Kavanagh J, Thomas J. Vaginal prostaglandin (PGE2 and PGF2α) for induction of labour at term. Cochrane Database Syst Rev. 2009;4:CD003101.

Scott JR. Intrapartum management of trial of labour after caesarean delivery: evidence and experience. BJOG. 2014;121(2):157-62

Ziyauddin F, Hakim S, Beriwal S. Transcervical Foley catheter versus the vaginal prostaglandin E2 gel in the induction of labour in a previous one caesarean section- a clinical study. J Clin Diagnost Res. 2013;7:1400-3 .

1Locatelli A, Regalia AL, Ghidini A, Ciriello E, Biffi A, Pezzullo JC. Risks of induction of labour in women with a uterine scar from previous low transverse caesarean section. BJOG. 2004;111(12):1394-9.

Jozwiak M, Dodd JM. Methods of term labour induction for women with a previous caesarean section. Cochrane Database Syst Rev. 2013;(3):CD009792.

Salva S, Nadeem FZ, Alfia Z, Rahat NQ. Increased risk of cervical canal infections with intracervical Foley catheter. J Coll Physicians Surg Pak. 2003;13(3):146-9.

Misra R. Ian Donald’s Practical Obstetric Problem, 7th Edition. BI Publications Pvt. Ltd; 2014.

Society of Obstetricians and Gynaecologists of Canada. Vaginal birth after previous Caesarean birth. Clinical Practice Guideline No. 68. Ottawa (ON): SOGC; December 1997.

Biswas A. Management of previous cesarean section. Curr Opin Obstet Gynecol. 2003;15(2):123-9.

Flamm BL, Urn OW, Jones C, Fallon D, Newman LA, Mantis K. Vaginal birth after cesarean section: results of a multicenter study. Am J Obstet Gynecol. 1988;158:1079-84.

Quilligan EJ. Vaginal birth after Cesarean section: 270 degrees. J Obstet Gynaecol Res. 2001;27(4):169-73.

Scott JR. Avoiding labor problems during vaginal birth after caesarean delivery. Clin Obstet Gynecol. 1997;40:533-41.

Rageth C, Juzi C, Grossenbacher H. Delivery after previous Caesarean: a risk evaluation. Obstet Gynecol. 1999;93:332-7.

Lovell R. Vaginal delivery after caesarean section: factors influencing success rates. Aust NZ J Obstet Gynaecol. 1996;36:4-8.

Hemalatha KR, Swetha D. Case series of Foley’s induction in patients with previous caesarean. Int J Reprod Contracept Obstet Gynaecol. 2017;6(4):1635-38.

Meetei LT, Suri V, Aggarwal N. Induction of labor in patients with previous caesarean section with unfavourable cervix. J Med Soc. 2014;28:29-33.

Scott JR. Intrapartum management of trial of labour after caesarean delivery: evidence and experience. BJOG. 2014;121(2):157-62.

Gonsalves H, Al-Riyami N, Al-Dughaishi T, Gowri V, Al-Azri M, Salahuddin A. Use of Intracervical Foley catheter for induction of labour in cases of previous caesarean section: experience of a single tertiary centre in Oman. Sultan Qaboos Univ Med J. 2016;16(4):e445-50.

Sananes N, Rodriguez M, Stora C, Pinton A, Fritz G, Gaudineau A, et al. Efficacy and safety of labour induction in patients with a single previous caesarean section: a proposal for a clinical protocol. Arch Gynecol Obstet. 2014;290(4):669-76.

Ben-Aroya Z, Hallak M, Segal D, Friger M, Katz M, Mazor M. Ripening of the uterine cervix in a post-cesarean parturient: prostaglandin E2 versus Foley catheter. J Matern fet Neonat Med. 2002;12(1):42-5.

McMaster K, Sanchez-Ramos L, Kaunitz AM. Evaluation of a transcervical Foley catheter as a source of infection: a systematic review and meta-analysis. Obstet Gynecol. 2015;126:539-51.

Huisman CM, Ten Eikelder ML, Mast K, Oude Rengerink K, Jozwiak M, van Dunné F, et al. Balloon catheter for induction of labor in women with one previous cesarean and an unfavorable cervix. Acta Obstet Gynecol Scand. 2019;98(7):920-8.






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