Efficacy of trans cervical Foley with or without extra amniotic saline infusion on induction delivery interval among women undergoing trial of labour after caesarean section at term: a randomized controlled trial.

OBJECTIVES: The study aimed to compare the induction-delivery interval after extra-amniotic saline infusion (EASI) plus a Foley catheter with a Foley catheter alone in women undergoing a trial of labour after cesarean. METHODS: This randomized, open-label clinical trial was conducted at a large tertiary care hospital in South India. Women more than 18 years with a single live intrauterine term gestation (>37 weeks), Bishop's score ≤ 5, intact membrane, reassuring fetal heart tracing and a history of one caesarean section were included. 22-French Foley catheter balloon tip was placed at the level of the internal os. The balloon was inflated with 60 mL of normal saline, and the catheter was gently retracted until resistance was felt. In the intervention arm, normal saline was infused through the catheter port at a rate of 60 ml/ hour for the first 6 hours. The control arm received only a Foley catheter. RESULTS: 190 women were found eligible for the trial of labour. The induction-delivery interval in the Foley catheter with EASI and Foley alone was comparable (21.57± 5.4 hours vs 21.65± 6 hours; p=0.92). Additionally, the incidence of vaginal birth after cesarean section was similar (53.7% vs 51.5%; p=0.97). Furthermore, no clinically significant change was noted in Bishop score {(4 (2-6) vs 3 (1-6); p=0.07)}. No differences in fever, scar dehiscence, or postpartum haemorrhage were reported. CONCLUSION: The addition of extra-amniotic fluid infusion to a Foley catheter does not shorten the induction-to-delivery interval in women undergoing trial of labour after cesarean.