The catheter is introduced into the endocervix by direct visualization or blindly by locating the cervix with the examining fingers and guiding the catheter over the hand and fingers through the endocervix and into the potential space between the amniotic membrane and the lower uterine segment.
The balloon reservoir is inflated with 30 to 50 mL of normal saline.
The balloon is retracted so that it rests on the internal os.
Additional steps that may be taken:

  • Apply pressure by adding weights to the catheter end.

    Constant pressure: attach 1 L of intravenous fluids to the catheter end and suspend it from the end of the bed.

    Intermittent pressure: gently tug on the catheter end two to four times per hour.

  • Saline infusion12: Inflate catheter with 40 mL of sterile water or saline.

    Infuse sterile saline at a rate of 40 mL per hour using an infusion pump.

    Remove six hours later or at the time of spontaneous expulsion or rupture of membranes (whichever occurs first).

  • Prostaglandin E2 infusion14