Balloon catheter for induction of labor in women with one previous cesarean and an unfavorable cervix

Abstract

Introduction When women with a previous cesarean section and an unfavorable cervix have an indication for delivery, the choice is to induce labor or to perform a cesarean section. This study aims to assess the effectiveness and safety of a balloon catheter as a method of induction of labor in women with one previous cesarean section and an unfavorable cervix compared with an elective repeat cesarean section. Material and methods We performed a prospective cohort study in 51 hospitals in the Netherlands on term women with one previous cesarean section, a live singleton fetus in cephalic position, an unfavorable cervix and an indication for delivery. We recorded obstetric, maternal and neonatal characteristics. We compared the outcome of women who were induced with a balloon catheter with the outcome of women who delivered by elective repeat cesarean section. Main outcomes were maternal and neonatal morbidity. Mode of delivery was a secondary outcome for women who were induced. Adjusted odds ratios (aOR) were calculated using logistic regression, adjusted for potential confounders. Results Analysis was performed on 993 women who were induced and 321 women who had a repeat cesarean section (August 2011 until September 2012). Among the women who were induced, 560 (56.4%) delivered vaginally and 11 (1.1%) sustained a uterine rupture. Composite adverse maternal outcome (uterine rupture, severe postpartum hemorrhage or postpartum infection) occurred in 73 (7.4%) in the balloon and 14 (4.5%) women in the repeat cesarean section group (aOR 1.58, 95% confidence interval [CI] 0.85‐2.96). Composite adverse neonatal outcome (Apgar score <7 at 5 minutes or umbilical pH <7.10) occurred in 57 (5.7%) and 10 (3.2%) neonates, respectively (aOR 1.40, 95% CI 0.87‐3.48). Women who were induced had a shorter postpartum admission time (2.0 vs 3.0 days (P < 0.0001)). Conclusions In women with a previous cesarean section and a need for delivery, induction of labor with a balloon catheter does not result in a significant increase in adverse maternal and neonatal outcomes as compared with planned cesarean section.

Time matters—a Swedish cohort study of labor duration and risk of uterine rupture

“…In our study, 7.5% of women with prior CS were induced with prostaglandins during the time period 2013-2018 and the rate did not decline after 2016 (result not presented). In concordance to prior reports, 9,23 we also found that women induced with a cervical catheter had no increased risk of uterine rupture. A systematic review of eight randomized controlled trials encompassing 707 women induced after a prior CS concluded that the studies were underpowered to detect clinically important outcomes such as uterine rupture and there was no clear evidence on the most efficient or safe method of induction in women with a prior CS.…”

“…[2][3][4] The rate of uterine rupture in women attempting a trial of labor after one previous low transverse CS has been estimated at between 0.2% and 1.5%, reflecting that selection for and management of trial of labor differ between healthcare settings and countries. 1,2,5,6,7,8,9 Efforts to improve safety of vaginal delivery after CS have focused on the identification of risk factors for uterine rupture, but few studies have examined the actual course of labor. [10][11][12] Recognition of clinical signs of uterine rupture is challenging due to the lack of specific symptoms; moreover, most signs do not precede, but follow, uterine rupture.…”

“…The main risk factor in medium‐ and high‐resource settings is a previous cesarean section (CS); rupture usually occurs in subsequent labor after onset of contractions 2‐4 . The rate of uterine rupture in women attempting a trial of labor after one previous low transverse CS has been estimated at between 0.2% and 1.5%, reflecting that selection for and management of trial of labor differ between healthcare settings and countries 1,2,5,6,7,8,9 . Efforts to improve safety of vaginal delivery after CS have focused on the identification of risk factors for uterine rupture, but few studies have examined the actual course of labor 10‐12 .…”

Mechanical Methods for the Induction of Labour After Previous Caesarean Section – An Updated, Evidence-based Review

“…aOR 1,32; 95 %-KI 0,37-4,72). Uterusrupturen nach Ballonkathetereinlage treten in der Regel nicht während der Zervixreifungsphase, sondern während der intravenösen Gabe von Oxytocin auf [21,36]. Nach intravenöser Anwendung von Oxytocin zur Geburtseinleitung nach Sectio wurde über eine Frequenz von Uterusrupturen von im Mittel 1,4 % (0,4-2,3 %) berichtet [5,41], die um das bis zu 3-Fache höher liegt als nach Abwarten spontaner Wehen [5,43].…”

“…Auch die Frage, ob bei medizinischer Indikation die Geburtseinleitung einer elektiven Re-Sectio vorzuziehen ist, bleibt unter Be-rücksichtigung von nur einer aktuellen Studie mit fehlender Randomisierung [36] unbeantwortet.…”