Mechanical methods of cervical ripening and labor induction.

Drexel University, 245 North 15th Street, MS 495, New College Building, Philadelphia, Pennsylvania 19102, USA.
Clinical Obstetrics and Gynecology (Impact Factor: 1.53). 10/2006; 49(3):642-57. DOI: 10.1097/00003081-200609000-00022
Source: PubMed

ABSTRACT This article reviews the safety and efficacy of mechanical agents for cervical ripening. Hygroscopic dilators, balloon catheters, and devices designed for cervical ripening have all been shown to be safe and effective for cervical ripening. Mechanical agents are as efficacious as other agents for cervical ripening. However, there is no method that has been conclusively shown to improve mode of delivery or perinatal outcome. The advantages of preinduction cervical ripening with mechanical devices include low cost, low incidence of systemic side effects, and low risk of uterine hyperstimulation.

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    ABSTRACT: To assess efficacy of the Foley catheter compared with the dinoprostone vaginal insert for beginning labor inductions at or near term. We performed a multicenter randomized controlled trial. We enrolled women at 36 weeks of gestation or greater with a singleton live fetus in cephalic presentation, intact membranes, an unfavorable cervix (dilation less than 3 cm; if 2 cm, less than 80% effaced), and no contraindication to labor or either study agent. Women were allocated to either a cervical Foley catheter inflated to 30 mL or dinoprostone for up to 12 hours. Oxytocin was allowed only after study agent removal. The primary outcome was time from agent placement to delivery. Secondary outcomes included delivery by 24 hours, vaginal delivery by 24 hours, time to vaginal delivery, cesarean delivery rate, and rate of tachysystole. Analysis was by intent-to-treat. We enrolled 376 patients, 185 allocated to Foley catheter and 191 to dinoprostone. In the Foley catheter group, time to delivery was shorter (median 21.6 compared with 26.6 hours; P=.003), more patients delivered within 24 hours (56% compared with 40%; P=.003), more delivered vaginally within 24 hours (44% compared with 30%; P=.004), and time to vaginal delivery was shorter (median 20.1 compared with 24.3 hours; P=.005). The cesarean delivery rates were 29% compared with 39% (P=.07). Uterine tachysystole occurred in 0% compared with 3% (P=.06). Starting labor inductions with a Foley catheter, compared with the dinoprostone vaginal insert, results in a shorter time to delivery and a higher proportion of women delivered and delivered vaginally within 24 hours. Cesarean delivery rates were not statistically significantly different.,, NCT01402050. LEVEL OF EVIEDENCE:: I.
    Obstetrics and Gynecology 05/2014; · 4.37 Impact Factor
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    ABSTRACT: Abstract Objective: To compare the efficacy of two mechanical devices for cervical ripening: double versus single balloon catheters, both with extra-amniotic saline infusion (EASI). Methods: Women at term with a singleton pregnancy presenting for labor induction were assigned to receive the double balloon catheter (with EASI) or the single balloon catheter (with EASI). Outcomes included time from device insertion to delivery, rates of successful vaginal delivery and occurrence of adverse events. Results: One hundred and eighty six women completed the study. Ripening success was comparable between the double and single balloon arms (96.4% vs. 92.7%, p=0.55, respectively). Balloon insertion to delivery interval was significantly shorter, and cesarean section rate was significantly lower in the double balloon arm compared to the single balloon arm (14.3 hours vs. 15.8 hours, p=0.04 and 8.3% vs. 20%, p=0.05, respectively). There were no significant differences in maternal characteristics, satisfaction or adverse outcomes. Conclusions: This study is the first documented assessment of the double balloon catheter combined with extra-amniotic saline infusion. Our findings suggest that the double balloon catheter results in reduced time to delivery and higher vaginal delivery rates, compared with the single balloon catheter with EASI, without compromising maternal or fetal safety.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 01/2014; · 1.36 Impact Factor
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    ABSTRACT: Abstract Objective: To compare the efficacy and safety of the trans-cervical double balloon catheter with and without extra-amniotic saline infusion (EASI) for cervical ripening. Methods: This is a secondary analysis of a prospective randomized study conducted between Nov 2007 and Jan 2011 evaluating different ripening methods. Women presenting for labor induction were assigned to receive the double balloon catheter with (study group) or without EASI (control group). Outcomes included time from device insertion to delivery, cesarean section rates, and adverse events. Results: One hundred and sixty women completed the study. Cesarean section rate (8.3% in study group, vs. 20% in controls p=0.07) and ripening success were comparable between the groups. Catheter insertion to delivery interval was significantly shorter and spontaneous catheter expulsion rate was significantly higher in the study group (14:19 hours vs. 20:45 hours, p<0.001, and 68.5% vs. 51%, p=0.04, respectively). Hospitalization length was significantly shorter in the study arm. There were no differences in other outcomes evaluated. A multivariable analysis found the EASI to be an independent predictor of a shorter insertion to delivery interval. Conclusions: The addition of EASI to the double balloon catheter for cervical ripening results in a shorter labor induction process without compromising its safety.
    Journal of Maternal-Fetal and Neonatal Medicine 06/2014; · 1.21 Impact Factor