665: Labor induction utilizing the Foley balloon: a randomized trial comparing delayed versus immediate removal

To determine whether immediate removal of the Foley balloon achieves a comparable vaginal birth rate to delayed removal. Prospective randomized controlled trial of women undergoing labor induction at Los Angeles County + University of Southern California Medical Center between June 1, 2010 and February 13, 2013. Subjects were assigned to either a) Foley balloon insufflation and delayed removal for standard indications (i.e. spontaneous expulsion, ROM) or b) Foley balloon insufflation and immediate removal after one minute. Oxytocin was administered to subjects who were not in active labor after 12 hours. Seventy seven women were randomized (35 delayed and 42 immediate removal). Subjects undergoing delayed removal were more likely to deliver within 24 hours (40.0% vs. 16.7%, p=0.02), however Cesarean birth rates were similar (26.2% vs. 28.6%, p=0.95) and total induction time differed only by 6 hours between groups (25.8 hrs vs. 31.7 hrs, p=0.003). Further, when the analysis was limited to parous women, no difference was observed in birth rates within 24 hours (42.1 vs. 33.3, p=0.60) or total delivery time (22.8 hrs vs. 25.0 hrs, p=0.31). Rates of maternal infection, epidural use, and abnormal APGAR scores were similar. A clinically relevant trend towards increased infection was found in the delayed removal group (17% vs. 5%, p = 0.13). Immediate removal of the Foley balloon results in a similar vaginal birth rate as delayed removal. Though immediate removal prolongs total induction time for nulliparas, there is no difference for parous women and no difference in resulting maternal or obstetrical complications.