Foley Catheter for Cerclage: A Case Report

A novel approach utilizing a Foley catheter to reduce bulging fetal membranes during emergency cerclage placement has demonstrated success in a recent case, offering a potentially simple adjunct to a complex obstetric procedure.

The case, initially reported in Cureus, involved a patient presenting with congenital incompetence of the cervix and pronounced bulging of the fetal membranes through the cervical os at 25 weeks gestation. Traditional cerclage, a procedure to reinforce the cervix, was complicated by the protruding membranes. Doctors successfully employed a modified Foley catheter technique to address the issue.

According to the report, the tip of a size 22 Foley catheter was removed. The bulb was then progressively inflated while applying gentle, sustained pressure to the bag of forewaters, effectively reducing the membranes back into the uterine cavity. Once reduced, the catheter bulb was further inflated with saline to a total volume of 25cc to maintain its position. This facilitated the subsequent insertion of a MacDonald cerclage around the internal cervical os.

The technique builds on established uses of Foley catheters in obstetrics. Research published in PubMed details a similar procedure, noting the use of saline to inflate the catheter bulb and maintain its placement during cerclage. A study available through the scholarlycommons.hcahealthcare.com highlights the use of a cervical ripening Foley balloon for membrane reduction at the time of cerclage placement, emphasizing the ease of controlled application afforded by the catheter’s stylet.

A three-step procedure for emergency cerclage, detailed in the International Journal of Environmental Research and Public Health, also incorporates a similar approach, noting the importance of keeping the bag reduced while the Foley catheter is in place. The suture is applied superficially to maintain reduction after the catheter is positioned.

Further research, published in Green Journal, confirms the use of cervical-ripening Foley balloons specifically for membrane reduction during physical examination-indicated cerclage.

The case report does not detail long-term outcomes for the patient or the fetus. The hospital involved has not released further information regarding the implementation of this technique beyond this single case.