Letter to the editor: Regarding 'The transcervical Foley balloon': A connection to cord prolapse?

To the Editor:

I read with interest the article titled “The transcervical Foley balloon” in the November 2013 issue of Contemporary OB/GYN and wanted to share my personal experience with this method of induction.

I first learnt of this method of induction about 2 years ago from the residents at my hospital, and I started using it on almost all the patients I admitted for induction from then on. I used a 30 ml Foley balloon and inflated it to 60–80 ml and attached it to the patient’s leg with traction with excellent results.

In July of this year, however, a patient of mine, whom I was inducing using this method, developed cord prolapse. And the same thing happened again with another patient in October of 2013. Two cord prolapses in a span of 3 months, compared with one in a span of 13 years previously, made me rethink the safety of this method of induction.

David Khodadadian, MD

New York, New York

In Reply:

We appreciate Dr. Khodadadian sharing his experience with the Foley balloon for cervical ripening. Though there is a theoretical risk for cord prolapse, and no doubt some cases have occurred, the data on this sequela are limited. Existing data do not show a significant increased risk of cord prolapse with the usual inflation volume with the Foley balloon cervical ripening.

In a study by Yamada et al inflation of the balloon with a large amount of fluid (70–250 ml) was associated with a higher rate of cord prolapse when compared to 70–150 ml. However, the rate of cord prolapse with the lower inflation volume (70–150 ml) was only 0.15%, and even that inflation volume is higher than what is typically used for cervical ripening (30–60 ml). Although the 2 cases of cord prolapse that Dr. Khodadadian reports are interesting, such a high rate of cord prolapse is not supported by the literature.

Tania F. Esakoff, MD

Sarah J. Kilpatrick, MD, PhD