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Transcervical foley catheter versus laminaria: A randomized controlled trial comparing efficacy and safety in facilitating cervical dilatation in cases of molar pregnancies

Raquel P. Adolfo, MD; Agnes L. Soriano-Estrella, MD, FPOGS, FPSSTD, MHPEd
Department of Obstetrics and Gynecology, University of the Philippines-Manila, Philippine General Hospital

Objective: This study aimed to compare the efficacy and safety of foley catheter versus laminaria in facilitating cervical dilatation among patients with molar pregnancy.

Methods: This was a randomized controlled trial carried out from September 1, 2013 to September 30, 2014. Fifty-two patients with hydatidiform mole were randomly allocated to either the control or treatment group. Laminaria was used in the control group to facilitate cervical dilatation prior to molar evacuation while foley catheter was used in the treatment group. The primary outcome was the rate of successful cervical dilatation. Amount of bleeding, level of pain, presence of foul smelling vaginal discharge, and febrile episode were noted. The two-tailed Wilcoxon rank sum test was used to determine difference between the two groups.

Results: A significantly higher rate of successful cervical dilatation was seen in the foley catheter group (1.6 mm/hr vs 1 mm/hr), as evidenced by shorter duration from placement of mechanical dilator to successful cervical dilatation (9.5 hours vs 12 hours) and the lack of need for insertion of additional cervical dilator (0 vs 1). Compared to laminaria, foley catheter took a significantly shorter time to insert (5 mins vs 1 min) and was significantly less painful (VAS 5 vs VAS 0). Estimated blood loss, relative risk for pelvic pain, febrile episodes, profuse bleeding, and foul smelling discharge did not differ significantly between the two groups.

Conclusion: Foley catheter may be an alternative in facilitating cervical dilatation for molar pregnancies. Foley catheter has the advantage of being readily available, with lower cost and lack of systemic or serious side effects.