Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UMASS Chan School of Medicine - Baystate Medical Center, Springfield, MA (Drs Schoen and Baker).
School of Medicine, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy (Dr Saccone).
Am J Obstet Gynecol MFM. 2022 Jul;4(4):100610. doi: 10.1016/j.ajogmf.2022.100610. Epub 2022 Mar 4.
Intracervical Foley catheter is a safe and effective method for cervical ripening. There are a variety of ways to modify this ripening method, including adding traction or tension to the catheter. The utility of this practice is uncertain. The aim of this systematic review and meta-analysis of randomized controlled trials was to investigate whether the placement of traction vs no traction on a Foley catheter during cervical ripening decreases total time from induction to delivery.
Electronic sources include MEDLINE, Scopus, ClinicalTrials.gov, the International Prospective Register of Systematic Reviews, SciELO, the Cochrane Central Register of Controlled Trials, and Google Scholar from inception through June 2020.
Randomized trials comparing Foley catheter with traction (ie, intervention) vs Foley catheter without traction (ie, control) for cervical ripening were included in the meta-analysis. All types of traction were analyzed (weighted, taped to thigh) and whether the traction was placed only initially at Foley catheter placement or repeated throughout the ripening process.
The primary outcome was the mean time from induction to delivery in hours. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of mean difference with 95% confidence interval. Heterogeneity was measured using I-squared (Higgins I).
Three trials including 790 singleton gestations were identified as relevant and included in the systematic review. Women randomized to traction on the Foley balloon had a similar time from induction to delivery compared with no traction (mean difference, 0.25; confidence interval, -0.78 to 1.27). No significant differences were found in the secondary outcomes. There was no difference in cesarean delivery between groups (relative risk, 0.94; 95% confidence interval, 0.74-1.19). Foley catheter expulsion was faster in the tension group (mean difference, -3.74; 95% confidence interval, -6.29 to -1.19) CONCLUSION: Adding traction to an intracervical Foley catheter during cervical ripening does not decrease time to delivery.
宫颈内 Foley 导管是一种安全有效的宫颈成熟方法。有多种方法可以修改这种成熟方法，包括向导管施加牵引或张力。这种做法的实用性尚不确定。本系统评价和随机对照试验的荟萃分析旨在研究在宫颈成熟过程中，Foley 导管上施加牵引与不施加牵引相比，是否会缩短从引产到分娩的总时间。
电子资源包括 MEDLINE、Scopus、ClinicalTrials.gov、国际前瞻性系统评价注册库、SciELO、Cochrane 中心对照试验注册库和 Google Scholar，从创建到 2020 年 6 月。
比较 Foley 导管加牵引（即干预）与 Foley 导管不加牵引（即对照）用于宫颈成熟的随机试验被纳入荟萃分析。分析了所有类型的牵引（称重、粘贴在大腿上），以及牵引是仅在 Foley 导管放置时最初放置还是在整个成熟过程中重复放置。
主要结局是从引产到分娩的平均时间（以小时计）。采用 DerSimonian 和 Laird 的随机效应模型进行荟萃分析，以产生平均差异的汇总治疗效果，并以 95%置信区间表示。采用 I 平方（Higgins I）测量异质性。
确定了三项试验，包括 790 例单胎妊娠，作为相关研究进行了系统评价。与无牵引相比，接受 Foley 球囊牵引的女性从引产到分娩的时间相似（平均差异，0.25；置信区间，-0.78 至 1.27）。两组次要结局无显著差异。两组剖宫产率无差异（相对风险，0.94；95%置信区间，0.74-1.19）。张力组 Foley 导管排出更快（平均差异，-3.74；95%置信区间，-6.29 至-1.19）。
在宫颈成熟过程中向宫颈内 Foley 导管施加牵引并不能缩短分娩时间。
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