What are the uses of Foley catheters in obstetric and gynecological settings?

Obstetric and Gynecological Uses of Foley Catheters

Foley catheters serve multiple critical functions in obstetric and gynecological practice beyond simple bladder drainage, including cervical ripening for labor induction, hemorrhage control, and postoperative urinary management.

Labor Induction and Cervical Ripening

Mechanical cervical ripening with Foley catheters is highly effective and safe for labor induction. 1

• Foley catheter pre-induction increases the Bishop score by an average of 2.68 points, with a 69.4% success rate resulting in delivery. 1
• The catheter is typically inserted with the balloon inflated to 50 mL and left in place until spontaneous expulsion or for 12-24 hours. 1
• In women with premature rupture of membranes (PROM), Foley catheter cervical ripening nearly halves the interval to delivery compared to prostaglandin use (736 vs 1354 minutes). 2
• The method does not increase risk of uterine over-stimulation, rupture, intrauterine infection, or adverse fetal outcomes. 1
• Multiparous women show higher efficiency of pre-induction with Foley catheters compared to primiparous women. 1

Hemorrhage Control and Prevention

Foley catheters function as effective temporary tourniquets for controlling peripartum hemorrhage, particularly in placenta accreta spectrum disorders. 3

• The catheter can be placed around the lower uterine segment and inflated to provide compression and tamponade bleeding vessels. 3
• For cervical and Cesarean scar pregnancies, ultrasound-guided Foley balloon placement effectively prevents or manages bleeding during treatment. 4
• In cases of cervical or Cesarean scar pregnancy treated with methotrexate, prophylactic balloon placement prevents hemorrhagic complications. 4
• Catheters are typically kept inflated for 1-6 days (mean 3.6 days) for hemorrhage control. 4
• The technique successfully controlled bleeding in all but one patient in a series of 18 cases of ectopic pregnancies. 4

Postoperative Urinary Management

After obstetrical anal sphincter injuries (OASIS), Foley catheter placement is mandatory to prevent urinary retention and allow proper healing. 5

• A Foley catheter should be placed before initiating third- or fourth-degree perineal laceration repair. 5
• A voiding trial on postoperative day 1 is recommended to ensure adequate bladder function before catheter removal. 5
• The catheter remains in place given the increased risk for urinary retention after complex perineal repairs. 5
• Proper bladder drainage prevents complications during the healing phase of sphincter repairs. 5

Diagnostic Applications in Gynecology

Foley catheters facilitate diagnostic imaging procedures for rectovaginal and vesicovaginal fistulas. 5

• For fluoroscopic vaginography, a large-gauge Foley catheter (26-gauge with 30-mL balloon) is placed in the vaginal lumen and inflated to prevent contrast spillage. 5
• Vaginography using Foley catheters demonstrates 79% sensitivity and 100% positive predictive value for identifying fistulous tracts. 5
• Water-soluble contrast is injected under fluoroscopic guidance with spot radiographs obtained in multiple views. 5
• The technique is particularly useful for complex fistulas with multiple branches, though low fistulas may be occluded by the balloon. 5

Important Safety Considerations

Several precautions minimize complications when using Foley catheters in obstetric and gynecological settings:

• For cervical ripening, complications include premature rupture of membranes (7.34%), early removal due to patient discomfort (10.09%), and rare bleeding (1.84%). 1
• When used for hemorrhage control in ectopic pregnancies, antibiotic prophylaxis is recommended in most cases (15 of 18 patients required antibiotics). 4
• C-reactive protein elevation after catheter insertion for cervical ripening remains within normal range for pregnancy (<12 mg/L). 1
• For diagnostic vaginography, water-soluble contrast is preferred over barium to prevent peritoneal contamination if the endometrial cavity fills. 5
• Standard adult Foley catheter sizing (14-16 Fr) is appropriate for most obstetric and gynecological applications. 6