{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:21:02Z","timestamp":1789802462426,"version":"4.0.1"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study evaluates forceful Foley balloon tugging for 30\u2009s 3\u2010hourly to retrieve a comfortably retained balloon compared to usual care (without tugging) during the 12\u2009h of planned passive placement. The primary outcomes were the induction (Foley insertion) to delivery duration and patients' satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Participants were recruited into a randomized controlled trial in a university hospital in Malaysia from March 2023 to December 2023. Nulliparas admitted for induction of labor by Foley balloon were enrolled. After Foley insertion, participants were randomized to 3\u2010hourly tugging or usual care. Following balloon retrieval (whether tugged out, spontaneously expelled, or at scheduled removal), suitability for amniotomy was assessed by vaginal examination. Follow\u2010on labor induction management was guided by the cervical finding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 264 patients were randomized, with 132 in each study arm. The primary outcomes of induction to birth duration median [interquartile range] was 33.2 [25.3\u201343.4] versus 37.2 [27.9\u201345.8] hours (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.058) and participant satisfaction score (0\u201310 numerical rating scale [NRS]) with the labor induction process was 9 [7\u201310] versus 9 [7\u201310]\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.437 for tugging versus usual care, respectively. Secondary outcomes with\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05 were Foley removal as planned at 12\u2009h, Foley displacement after tugging, compliance to protocol, and umbilical artery blood pH. However, pH \u22647.10 was 2\/126 (1.6%) versus 3\/129 (2.3%) relative risk 0.67 95% CI 0.11\u20133.95\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.99 for tugging vs. usual care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>At nulliparous Foley induction of labor with a planned 12\u2010h ballon placement, tugging the Foley 3\u2010hourly compared to usual care did not expedite birth or increase patient satisfaction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70920","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T12:25:07Z","timestamp":1774268707000},"page":"1468-1478","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tugging the Foley catheter balloon every 3\u2009h in nulliparous induction of labor: A randomized controlled trial"],"prefix":"10.1002","volume":"174","author":[{"given":"Muhamad Aznor","family":"Aqwa Azman","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukhri","family":"Hamdan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thai Ying","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"Gan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahmah","family":"Saaid","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8713-6581","authenticated-orcid":false,"given":"Peng Chiong","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Universiti Malaya  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"WHO Recommendations: induction of Labour at or Beyond Term","author":"World Health Organization","year":"2018"},{"key":"e_1_2_12_3_1","unstructured":"NHS Maternity Statistics England \u2013 2020\u201021.https:\/\/digital.nhs.uk\/data\u2010and\u2010information\/publications\/statistical\/nhs\u2010maternity\u2010statistics\/2020\u201021. 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