INDUCTION OF LABOR IN POST DATED PREGNANCY WITH INTRA-CERVICAL FOLEY CATHETER IN ANTENATAL WARD OF B . P . KOIRALA INSTITUTE OF HEALTH SCIENCES DHARAN , NEPAL

This was a descrip ve observa onal study. Pa ents admi ed in antenatal ward of BP Koirala Ins tute of Health Sciences (BPKIHS) with period of gesta on (POG) ≥ 41 weeks without any complica ons were taken. Pa ents were induced either with Foley catheter or directly with misoprostol. Pa ents induced with Foley catheter were included in the study. Sixteen French Gauge Foley catheter was inserted intracervically and bulb was inflated with 4060 ml of dis lled water and observed for 24 hours. If pa ent didn't go into labor a er 24 hours with or without Foley expulsion, pa ent was reassessed and prostaglandin was used for further induc on. Structured Pro forma was used for data collec on and collected data was analyzed using SPSS so ware 11.5.


Methodology
This was a descrip ve observa onal study.Pa ents admi ed in antenatal ward of BP Koirala Ins tute of Health Sciences (BPKIHS) with period of gesta on (POG) ≥ 41 weeks without any complica ons were taken.Pa ents were induced either with Foley catheter or directly with misoprostol.Pa ents induced with Foley catheter were included in the study.Sixteen French Gauge Foley catheter was inserted intracervically and bulb was inflated with 40-60 ml of dis lled water and observed for 24 hours.If pa ent didn't go into labor a er 24 hours with or without Foley expulsion, pa ent was reassessed and prostaglandin was used for further induc on.Structured Pro forma was used for data collec on and collected data was analyzed using SPSS so ware 11.5.

Results
During the study period 353 pa ents were induced with intracervical Foley catheter.Among them 97(27.48%)went to labor and 256 (72.52%) needed further prostaglandin.Among 97 pa ents who went to labor 80 had normal vaginal delivery, 16 underwent cesarean sec on and one pa ent had vacuum assisted vaginal delivery.There were nine pa ents who had delivered baby with meconium stained liquor.Four pa ents had postpartum hemorrhage and two pa ents had ntrapartum fever.None of the pa ents had hyper s mula on syndrome but one pa ent had s ll birth.

METHODOLOGY
This study was conducted in antenatal ward of BP Koirala Ins tute of Health Sciences (BPKIHS).It was a descrip ve study.Ethical approval was taken from ins tu onal review commi ee of BPKIHS before star ng the study.Dura on of the study was about six months.Women with period of gesta on (POG) ≥ 41 weeks without exclusion criteria were recruited.All the pa ents with POG ≥ 41 weeks in BPKIHS were induced either with intracervical Foley or with vaginal misoprostol.This study included pa ents who were induced with intracervical Foley only.Exclusion criteria included those pa ents with hypertension, diabetes mellitus, leaking per vaginum, oligohydraminos and previous uterine surgeries.The par cipants were given wri en informa on about the study and for those who agreed to par cipate informed consent was obtained prior to inclusion into the study.
Bishop Score was assessed by resident doctor.If score < 6. Foleys catheter 16 FG was inserted intracervically with asep c precau ons and balloon inflated with 40-60 ml of dis lled water.External end of catheter was fixed on thigh without trac on.If Foley can't be inserted, the pa ent was excluded from the study.Foley catheter was removed a er 24 hours if not expelled itself.If it expelled out it was not reinserted and observed for 24 hrs from Foley inser on.It was removed if woman requested to and not removed even if there was rupture of membranes.If pa ent went into labor she was shi ed to labor room and managed accordingly.If pa ent had no labor a er 24 hours, she was reassessed and misoprostol was inserted per vaginum.She was followed up un l delivery if she went into labor.Maternal and fetal outcomes were noted.
The maternal outcomes were the mode of delivery, induc on to delivery interval and complica ons like maternal infec on and postpartum hemorrhage.Neonatal outcomes include meconiun stained liquor, Apgar score at five minutes and s ll birth.When there was more than one indica on for caesarean sec on, the primary indica on was categorized.For intrapartum infec on any two of the following should be present; maternal fever (≥38 °C) during labor, fetal tachycardia (≥160 bpm), uterine tenderness, purulent amnio c fluid or vaginal discharge and total white 3 cell count > 20,000/mm.An bio cs were prescribed for them.
The data were entered in MS excel and analyzed using SPSS version 11.5.Categorical variables were described using frequency distribu on and percentages.Con nuous variables were expressed by means and standard devia ons.

RESULTS
Baseline characteris cs of the pa ents are shown in

DISCUSSION
Induc on of labor is one of the commonest procedures done in obstetrics.Many researches were done regarding the methods and medica on for induc on.Each method has its own risks and benefits.In Nepal conven onally most of the hospitals are prac cing induc on at 41 weeks of gesta on for women with otherwise uncomplicated pregnancies.They are using either mechanical methods like Foley catheter or the prostaglandins.In this study we recruited 353 pa ents who have reached at least 41 weeks period of gesta on.
This study shows the series of labor induc on in postdated pregnancy with Foley catheter only and shows the efficacy in term of pa ents going to labor in 27 Induc on is one of the common procedures and failed induc on is one of the commonest causes of cesarean sec on.The strength of this study is that our study took place at one ins tu on that limits prac ce varia on and more easily ensures compliance with the labor protocol and pa ents are chosen as postdates with no other complica ons making them more homogenous so outcome is not affected.

CONCLUSION
Women with postda sm can be induced with intra-cervical Foley catheter with few complica ons of both mother and fetus.

RECOMMENDATIONS
Foley catheter can be a safe alterna ve which is easy, cheap and with minimal risk for induc on of labor.So it can be prac ced in all the ins tute of Nepal.Future study should focus on valida ng in different popula on and not only in postda sm and should be large enough to evaluate maternal and neonatal outcomes.Future inves ga on about mechanical methods for induc on should also focus on the possibility of outpa ent priming of cervix with these methods.

LIMITATION OF THE STUDY
This is a descrip ve study showing the effect of Foley catheter in postdated pregnancy.It doesn't include other indica ons for induc on.So it couldn't be generalized to all the pa ents.Also this study doesn't involve all variety of pa ents that needs induc on and involve only postdated pa ents.

Table 1 :
Baseline characteris cs of the pa ents (n= 353) [12][13][14][15] Health Sciences Vol.3/No.1/Issue5/Jan-April2018Dixit B et al cervical ripening with extra amnio c catheter balloon possess advantage of simplicity, low cost, reversibility, lack of systemic side effects and efficiency similar or be er than 8-10 other methods.Foleys catheter causes change in cervical dilata on through both direct mechanical dilata on and stretch induced release of endogenous prostaglandins.Cochrane meta analysis also found that use of Foleys catheter for cervical ripening has be er safety profile than prostaglandins with less tachysystole and fetal heart rate 11 changes.Although there has been concern about increased risk of infec on associated with use of Foley catheter; this has not been demonstrated in randomized[12][13][14][15]controlled trials.Study in intra-cervical Foley catheter as inducing agent is lacking in Nepal.This study was designed to know the effect of Foley catheter for induc on in postdated pa ents.

Table 3 :
Indica ons for cesarean delivery (n=97) done by Ten eikelder Ml et al. on induc on of labor using Foley or misoprostol showed very few hypers mula on syndrome and less cesarean deliveries for non reassuring NST in the Foley group which is comparable to our study.