Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice?

Abstract

IntroductionWe analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery.Materials and methodsWe designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score <5), a prior cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value <0.05 was considered statistically significant.ResultsMost women improved their initial Bishop Score (89.5%) although only a 20.8% of them went into spontaneous active labour. Finally, 51.4% of the women achieved a vaginal delivery. Five cases of intrapartum uterine rupture (1.2%) occurred. After multivariate analysis, main risk factors for repeated cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066–2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066–6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959–6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004–1.006). The area under the curve was 0.789 (p < 0.001).ConclusionsDouble-balloon catheter seems to be safe and effective for cervical ripening in women with a previous cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section.

Predictive factors for successful cervical ripening using a double‐balloon catheter after previous cesarean delivery

“…Table 4 compares the findings of these investigations with those of the present study. The present cohort was the second only to that of De Bonrostro et al 16 in terms of size (105 vs 418 women), with the remaining seven studies enrolling between eight and 50 women. Similar to the present study, three studies reported that cervical ripening with DBC was useful and safe, resulted in a two-fold increase in the initial Bishop score, with cesarean delivery rates of approximately 40%-50%, and no substantial increased risk of perinatal adverse events.…”

“…Table compares the findings of these investigations with those of the present study. The present cohort was the second only to that of De Bonrostro et al . in terms of size (105 vs 418 women), with the remaining seven studies enrolling between eight and 50 women.…”

“…Eight studies [16][17][18][19][20][21][22][23] have specifically reported on the use of DBC for cervical ripening among women with PCD and an unfavorable cervix. Table 4 compares the findings of these investigations with those of the present study.…”

“…Similar to the present study, three studies reported that cervical ripening with DBC was useful and safe, resulted in a two-fold increase in the initial Bishop score, with cesarean delivery rates of approximately 40%-50%, and no substantial increased risk of perinatal adverse events. [16][17][18] French clinical guidelines indicated that the Foley catheter was an effective tool for IOL, with three factors strongly associated with successful VBAC: history of vaginal delivery after PCD, spontaneous labor, and favorable cervix. 2 In the present study, only the initial Bishop score at the time of installation and the Bishop score after removal of DBC appeared to be predictive of VBAC.…”

Risk Factors of Intra-Amniotic Infection Related to Induction with Single-Balloon Catheter: A Case-Control Study

“…It allows cervical ripening, causing less uterine overstimulation [1]. Cases of oligohydramnios, fetal growth restriction, pregnancy complicated with asthma, hypertension, and uterine scarring favor a balloon catheter for cervical ripening due to the high risk of using prostaglandins [1,[3][4][5].…”