(926) Patients’ expected versus experienced discomfort with foley balloon use for induction of labor

Patients often defer or decline the use of a foley balloon (FB) for induction of labor (IOL) due to concern for significant discomfort. This study compares patients’ expected versus experienced discomfort with FB use for IOL.

Study Design:

Patients ≥ 18 years-old presenting for IOL with intact membranes were surveyed at the start of induction to assess expected discomfort (0-10 pain scale) with FB placement and while the FB remains in place. Patients who underwent FB placement and completed the initial survey completed a follow-up survey after FB removal or unsuccessful placement to assess experienced discomfort. Discomfort is presented as mean and standard deviation.

Results:

Over a 2-month period, there 366 inductions and 183 (50%) completed the initial survey. 92 (50.3%) completed the initial survey underwent FB placement and 76 (82.6%) of these completed the follow-up survey (Table 1). Four patients received neuraxial anesthesia prior to FB placement and were excluded. There was no significant difference between experienced and expected discomfort during FB placement (5.8 ± 2.7 vs. 6.2 ± 2.2, p= 0.22). However, patients experienced less discomfort than expected while the FB remained in place (5.1 ± 2.8 vs. 5.8 ± 2.1, p= 0.02). Hydromorphone use (0.5 mg IV and 1.0 mg subcutaneous) prior to FB placement was associated with a significant reduction in the experienced versus expected discomfort while the FB remained in place (4.5 ± 2.6 vs. 6.6 ± 2.2, p= 0.01) but not during placement (6.5 ± 2.8 vs. 7.0 ± 2.6, p= 0.45). Among those not receiving hydromorphone, no differences were observed between experienced and expected discomfort for FB placement (5.5 ± 2.6 vs. 5.8 ± 1.9, p= 0.34) or while in place (5.3 ± 2.9 vs. 5.4 ± 2.0, p=0.45).

Conclusion:

Patients experience less discomfort than expected while the FB remains in place, but not during placement. This reduction appears to be mediated by hydromorphone. Patients expecting significant discomfort while a FB remains in place benefit from the use of hydromorphone.