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A reader writes regarding the November 2013 article "The transcervical Foley balloon." Are there any data that this method of induction is connected to higher rates of umbilical cord prolapse?
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
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