Evaluation of a Transcervical Foley Catheter as a Source of Infection A Systematic Review and Meta-analysis

OBJECTIVE:To evaluate associations between Foley catheter use for cervical ripening and infectious morbidity.DATA SOURCES:We searched computerized databases, references in published studies and textbook chapters without language restriction. Searches were performed in MEDLINE, PubMed, ClinicalTrials.gov, Web of Science, and the Cochrane Library from inception through December 2014. MeSH headings used included the terms Foley catheter, Foley balloon, prostaglandin, labor induction, and cervical ripening.METHODS OF STUDY SELECTION:We identified randomized controlled trials that compared Foley catheter with locally applied (vaginal or cervical) prostaglandin preparations for cervical ripening or labor induction. Selected studies evaluated maternal or neonatal infection with at least one of the following outcomes: chorioamnionitis, endometritis, pooled maternal infection, and neonatal infection. Excluded studies used double-balloon catheters, outpatient Foley management, extraamniotic saline infusions, pregnancy termination, and oral administration of medication in the prostaglandin arm.TABULATION, INTEGRATION, AND RESULTS:We identified 26 randomized trials including 5,563 women. Compared with prostaglandin preparations alone, patients who underwent cervical ripening with a Foley catheter had similar rates of chorioamnionitis (56/782 [7.2%] with Foley compared with 54/754 [7.2%] with prostaglandins; relative risk [RR] 0.96; 95% confidence interval [CI] 0.66-1.38), endometritis (40/1,042 [3.8%] compared with 35/991 [3.5%]; RR 1.03, 95% CI 0.66-1.6), pooled maternal infection (237/2,699 [8.8%] compared with 257/2,864 [9%]; RR 0.95, 95% CI 0.81-1.12), and neonatal infection (34/1,061 [3.2%] compared with 39/1,074 [3.6%]; RR 0.9, 95% CI 0.58-1.39). With subgroup analysis, excluding studies using preinsertion cervical cleansing or prophylactic antibiotics in the Foley arm, results were similar.CONCLUSION:Use of transcervical Foley catheters for cervical ripening and induction of labor is not associated with an increased risk of infectious morbidity.