Increased risk of cervical canal infections with intracervical Foley catheter.

OBJECTIVE: To evaluate the effect of intracervical Foley catheter insertion, for the induction of labor, on cervical canal infection. DESIGN: A prospective interventional study with paired analysis. PLACE AND DURATION OF STUDY: The study was conducted in the department of Obstetrics and Gynecology at the Aga Khan University, Karachi, between June 1 and August 31, 2002. SUBJECTS AND METHODS In 45 women undergoing cervical ripening with intracervical Foley catheter for the induction of labour at term, cervical swabs were taken for culture and sensitivity before its insertion and again after its spontaneous expulsion or removal. RESULTS: Intracervical Foley catheter was retained for mean duration of 8.1 +/- 1.7 hours. There was a significant change in the pathogenic organisms (0 % v 16.3 %; p 0.016) from pre-Foley to post-Foley catheter cervical swab cultures. Growth of beta-hemolytic Streptococcus group-B, Candida albicans, Candida glabrata and Gardnerella vaginalis on cervical swab were considered pathogenic. One woman (2.2 %) developed fever following insertion of intracervical Foley catheter. No statistically significant effect of potential confounding factors was observed on change in growth of pathogenic organisms. CONCLUSION: Induction of labour at term with Foley catheter is associated with a significant increase in intracervical pathogenic organisms despite undertaking routine aseptic measures. We recommend evaluation of this technique for its potential infectious harm in larger studies. Meanwhile, extreme aseptic measures should be undertaken during its insertion to avoid maternal and possible neonatal infections.

Clinical governance in the management of induction of labour.

OBJECTIVE: To determine whether dissemination of explicit guidelines, developed in consensus with stakeholders, for the processes of induction of labour (IOL), results in reduction of variability in clinical practice. DESIGN: A prospective behaviour modification interventional study. PLACE AND DURATION OF STUDY: The study was conducted in the department of Obstetrics and Gynaecology at the Aga Khan University, Karachi, between January 1 and August 31, 2002. SUBJECTS AND METHODS: In a total of 142 conveniently sampled women, undergoing IOL, pre-identified quality assessment indicators were measured. After collection of data from initial 71-women (pre-intervention group) mutually agreed guidelines for clinical practice were disseminated, over a period of time, among consultants, residents and nurses. These indicators were again measured in subsequent 71 women (post-intervention group) to evaluate magnitude of residual non-conformities in these processes. RESULTS: Following behaviour modification interventions, nonconformities in consultants and residents-dependent processes like timely review of patients by consultants (72 vs 1.4%, p value <0.0001), documentation of indication for IOL (66.2 vs 16.9%, p value <0.0001), method of induction for IOL (56.3 vs 28.2%, p value 0.0001), and calculation of Bishop score before IOL (38.0 vs 4.2 %, p value <0.0001) were significantly reduced. CONCLUSION: Dissemination of explicit guidelines developed in consensus with stakeholders significantly reduces variability in clinical practice. Our model can be used for improving quality of care in other areas of obstetric health care.