Incidence of post-dated pregnancy is 5 to 10 %. Induction of labour is a common obstetric intervention. Induction of labour is done by pharmacological, surgical and mechanical methods, with the aim to achieve a normal vaginal delivery. It is done when the benefit of delivery outweigh the risk of continuing pregnancy. There are various maternal and fetal indication for induction of labour. In this study post-dated pregnancy with unfavourable cervix is taken into consideration, since it is commonest cause. In our department we admitted the otherwise uncomplicated post-dated pregnant women with GA ≥41weeks with unfavourable cervix. There are various methods to ripe the unfavourable cervix and induction of labour. Undoubtedly cervical ripening had a close relationship with the success of delivery. It has be authorised that ripening of cervix with intra cervical Foley catheter possess preference of cost effective, simple procedure, reversibility, lack of uterine hyper stimulation, less fetal heart rate changes. Foleys catheter causes cervical dilatation through both direct mechanical dilatation and stretch induced release of endogenous prostaglandin. Concerns about increased risk of infection associated with the use of Foley catheter was only in milder form which was prevented with prophylactic use of capsule Amoxicillin while induction.
Methodology: This cross sectional observational study on induction of labour with intra cervical Foley catheter instillation in post-dated pregnancy was carried out in the Department of Obstetrics and Gynaecology in a semi urban based tertiary care centre Government Vellore Medical College from June 2019 to May 2020. During this study period 200 post-dated pregnant women with gestational age ≥41 weeks with unfavourable, with no maternal and fetal complication were included. Sixteen French Gauge Foley Catheter was inserted intra cervical and the Foleys bulb was inflated with 60ml of normal saline. Induction period was 24 hours. Maternal and fetal parameters were monitored. If the patients didn’t go for labour within the 24 hours they were reassessed and further need of prostaglandin were given. Structured protocols was prepared for data collection and data collected during this study was analysed with SPSS software 11-5.
Results: In this study 200 post-dated pregnancy patients with unfavourable cervix were selected and induction of labour was done with intra cervical Foleys catheter. Induction period was 24 hours. In this study 167 patients went in for labour pain. Remaining patients who didn’t go for labour pain were reassessed and further prostaglandin were used for induction of labour. Among 167 patients 138 patients had vaginal delivery, 26 patients had caesarean section and 3 patients had vacuum assisted vaginal delivery, 5 patients had PPH, 2 patients had intrapartum fever and 2 babies were admitted in NICU. No patient uterine hyper stimulation.
Conclusion: Induction with intra cervical Foleys catheter is effective method for ripening of cervix in post-dated pregnancy with unfavourable cervix to achieve a vaginal delivery with less maternal and fetal complication.