Pregnancy outcomes after failed cervical ripening with prostaglandin E2 followed by Foley balloon catheter

Objective: To study pregnancy outcomes of cervical ripening with Foley catheter, in women who failed to respond to prostaglandin-E2 (PGE2). Methods: A retrospective cohort study of all patients with a singleton pregnancy, who underwent cervical ripening with vaginal PGE2, between 2013 and 2014, was performed. Patients who failed to respond to a total dose of 6–9 mg PGE2, defined as no change in Bishop score, underwent subsequent ripening with Foley catheter (non-responders group). Data were compared to patients who achieved sufficient response to a total dose of up to 9 mg PGE2 (responders group). Results: Compared with the responders group (n = 813), patients in the non-responders group (n = 49) had higher rates of nulliparity (p < 0.001), pre-induction cervical dilation ≤1 cm (p = 0.004), pre-induction cervical effacement ≤50% (p = 0.01) and birth weight >4000 g (p = 0.02). A significantly higher cesarean delivery rate was observed in the non-responders group (51 versus 12.3%, p < 0.001). Failed ripening with PGE2 was found to be independently associated with cesarean delivery (aOR = 5.11, 95% CI = 2.72–9.62). Conclusions: The need for an additional cervical ripening method after failure with PGE2 is associated with a very high risk of cesarean delivery. This is particularly significant in nulliparous women, women carrying large fetuses, and women presenting with a low Bishop score.