McGee Therese M, Gidaszewski Beata, Khajehei Marjan, Tse Toni, Gibbs Emma
Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
Sydney Medical School Westmead, University of Sydney, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2019 Apr;59(2):235-242. doi: 10.1111/ajo.12828. Epub 2018 Jun 26.
Both silicone and latex single-balloon Foley catheters are available for cervical ripening but no literature exists to compare them. Local experience suggested more frequent insertion-related accidental rupture of the membranes (acROM) with silicone.
To compare the performance of silicone versus latex catheters with respect to acROM and other outcomes.
Women undergoing outpatient Foley catheter cervical ripening were randomised to a silicone or latex catheter. Data were collected on the primary outcome, acROM, and secondary outcomes including catheter insertion failure, unplanned hospital admission and patient-reported discomfort, together with intrapartum fever and antibiotics for suspected chorioamnionitis along with general obstetric and neonatal outcomes.
Among 534 recruited women, acROM was significantly more common with a silicone compared to a latex catheter at 7.2% (19/265) versus 1.5% (4/269) (relative risk (RR) 4.8; 95% CI 1.7-14.0). Insertion failure was significantly less common with silicone than latex at 2.6% (7/265) versus 9.3% (25/269) (RR 0.3; 95% CI 0.1-0.6). However, when the alternative catheter was subsequently tried, the final failure rates were 1.9% silicone (5/265) versus 2.6% latex (7/269). Insertion-related hospital admission was higher with silicone at 9.4% (25/265) than latex at 4.8% (13/269) (RR 2.1; 95% CI 1.1-4.1). All other obstetric outcomes were similar between the groups.
When used for cervical ripening, a silicone Foley catheter is associated with a higher rate of acROM than a latex catheter but a lower rate of insertion failure. It may, therefore, be reasonable to attempt insertion with a latex catheter initially and manage insertion failures with a silicone catheter.
硅胶和乳胶单球囊 Foley 导管均可用于宫颈成熟，但尚无文献对二者进行比较。当地经验表明，使用硅胶导管时，与插入相关的胎膜意外破裂（acROM）更为常见。
比较硅胶导管和乳胶导管在 acROM 及其他结局方面的表现。
接受门诊 Foley 导管宫颈成熟的女性被随机分配至使用硅胶导管或乳胶导管组。收集关于主要结局 acROM 和次要结局的数据，次要结局包括导管插入失败、意外住院、患者报告的不适，以及产时发热和因疑似绒毛膜羊膜炎使用的抗生素，还有一般产科和新生儿结局。
在 534 名招募的女性中，硅胶导管组的 acROM 明显比乳胶导管组更常见，分别为 7.2%（19/265）和 1.5%（4/269）（相对风险（RR）4.8；95%置信区间 1.7 - 14.0）。硅胶导管的插入失败明显比乳胶导管少见，分别为 2.6%（7/265）和 9.3%（25/269）（RR 0.3；95%置信区间 0.1 - 0.6）。然而，当随后尝试使用另一种导管时，最终失败率硅胶导管为 1.9%（5/265），乳胶导管为 2.6%（7/269）。与插入相关的住院率硅胶导管组为 9.4%（25/265），高于乳胶导管组的 4.8%（13/269）（RR 2.1；95%置信区间 1.1 - 4.1）。两组间所有其他产科结局相似。
用于宫颈成熟时，硅胶 Foley 导管的 acROM 发生率高于乳胶导管，但插入失败率较低。因此，最初尝试使用乳胶导管插入，若失败则使用硅胶导管处理可能是合理的。
