When at first you don't succeed at inserting a transcervical Foley catheter....try this!

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Although inserting a transcervical Foley catheter can be a good way to achieve cervical ripening before inducing labor, when clinicians try to insert one, they're unable to do so up to 20% of the time.

Although inserting a transcervical Foley catheter can be a good way to achieve cervical ripening before inducing labor, when clinicians try to insert one, they're unable to do so up to 20% of the time. Discomfort to the woman during insertion has also limited the use of catheters for this purpose. But one poster presented at this year's ACOG meeting reported on a new technique using a rigid stylet during insertion that's said to improve the likelihood of success.

Researchers tried this technique successfully in 16 patients for whom conventional attempts had failed. A 5F rigid catheter guide (Bard Urological Products, Murray Hill, N.J.) was inserted into the Foley catheter to make the instrument rigid. Guided by the obstetrician's hand, the rigid guide-the same stylet used during Ulmsted's TVT procedure-and a Foley catheter were inserted transcervically. After the catheter balloon was inflated, the stylet was removed from the Foley catheter.

Although the numbers were small (16 patients), placement was 100% successful with the new technique. The median preplacement Bishop score was 1 (0-4), while the median postplacement Bishop score was 5 (0-11); P<0.001). An accidental amniotomy was the lone complication. Investigators concluded that a rigid stylet makes it easier to insert a transcervical Foley catheter for cervical ripening, making that an option for patients with a Bishop score less than or equal to 4 who require labor induction.

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