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

Abstract

INTRODUCTION:

We 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 METHODS:

We 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.

RESULTS:

Most 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).

CONCLUSIONS:

Double-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.

• Authors: Carlos De Bonrostro Torralba, Eva Lucía Tejero Cabrejas, Sabina Marti Gamboa, María Lapresta Moros, Jose Manuel Campillos Maza, Sergio Castán Mateo
• Journal: Archives of gynecology and obstetrics (Arch Gynecol Obstet) Vol. 295 Issue 5 Pg. 1135-1143 (May 2017) ISSN: 1432-0711 [Electronic] Germany
• PMID: 28315935 (Publication Type: Journal Article)

Chemical References

• Oxytocin

Topics

• Adult
• Catheterization (adverse effects, methods)
• Cervical Ripening (physiology)
• Cervix Uteri
• Cesarean Section
• Cesarean Section, Repeat (statistics & numerical data)
• Delivery, Obstetric (methods)
• Dystocia (epidemiology)
• Female
• Fetal Macrosomia (epidemiology)
• Humans
• Labor, Induced (adverse effects, methods)
• Oxytocin (administration & dosage)
• Parturition
• Pregnancy
• Retrospective Studies
• Risk Factors
• Trial of Labor
• Uterine Rupture (epidemiology)
• Vaginal Birth after Cesarean (adverse effects)
• Young Adult