Comparative Study on Effect of Hygroscopic Dilators Versus Foleys Balloon Catheter Insertion on Outcome of Preinduction of Labour: Prospective Study

Abstract

Introduction: A procedure to artificially start uterine contractions that eventually cause cervix to elongate and efface is known as inducing labor. The infant should therefore preferably be delivered vaginally.

Before initiating induction, it is important to confirm gestational age and fetal lung maturity.

Labor induction is one of the interventions that is most frequently utilized today. Up to 20% of women worldwide have labor that is induced using one of two methods. “The advancement in oxytocics and induction techniques has made the process of induction easier, safer, more efficient, and predictable compared to the older methods”2.

Aim:

To calculate the impact of hygroscopically dilators on uterine cervix ripening.

To research the progression and results of labor during hygroscopically induced labor.

To calculate the impact of the Foley catheter on uterine cervix ripening.

To examine the progression and results of labor when it is induced using a Foley catheter.

In the context of labor induction, the goal is to assess how hygroscopic dilators and the Foley catheter affect cervical dilation, the length of induction, maternal outcomes, and fetal outcomes.

Methodology:

The prospective study was carried out at Chennai's Government RSRM Lying In Hospital between December 2018 and September 2019. For 120 patients who were term pregnant moms eligible for induction, Bishop scores were determined. If the bischop score was less than 6, they were randomly assigned to the hygroscopic dilator group and the foleys group. Between these 2 group, analyses and comparisons of patient characteristics and outcomes were made. The mode of delivery was the study's main endpoint. “Measured and analyzed secondary outcomes included post-insertion bishop score, insertion delivery interval, induction delivery interval, apgar at 1 and 5 minutes, and need for PGE2 gel”3.

Results:

Compared to 71.7%  in control group, 73.3% in study group experienced natural labor (p value = 0.838). 20% of the study group underwent emergency LSCS, compared to 26% of the control group (p value = 0.387). Consequently, the major result between these groups does not differ statistically from the other groups.

In comparison to 60.5% of instances in the control group, the insertion delivery interval was between 12 and 24 hours in 77.1% of patients with primi (p value = 0.025).

“For Multigravida insertion delivery interval is 12 to 24 hours in study group in 80% of instances, 12 to 24 hours in study group in 40.9% of cases, and more than 24 hours in 40.9% of cases”4. The gap between induction delivery was insignificant (p value = 0.671). In 10% of instances in the research group and 31.7% of cases in the control group, no PGE 2 gel was applied. In the study group, one gel was utilized in 76.7% of instances, two gels in 11.7%, and three gels in 1.7% of cases.

One gel was used in 36% of cases and two gels in 5% of instances in the control group. The difference between the study group's and control group's use of PGE 2 gel is statistically significant. “The study group and control group do not show a statistically significant difference (p value = 0.120) in the 1- and 5-minute Apgar scores”6. However, there is a significant statistical difference (p value = 0.033) between the post-insertion Bishop scores of  study group and control group, with the former having higher scores.

Conclusion:

Dilapan S has preinduction results that are safe and comparable to those of a foleys balloon catheter when used at term.