To systematically review the application of balloon
catheters for cervical ripening and
labor induction at term after previous
cesarean section. All pregnancies at term with previous
cesarean section were included when cervical ripening or
labor induction was conducted with balloon
catheters. MEDLINE, Cochrane database and bibliography of identified articles were searched for English language studies. Reviews and meta-analysis, randomized and non-randomized controlled trials, prospective and retrospective cohort studies as well as case-control studies were considered. A total of 48 potentially relevant studies were identified. The title and abstract were screened for eligibility and 32 articles were excluded. The remaining 16 publications included 1447 women (single-balloon
catheter: n=1329, double-balloon
catheter: n=118). There were no randomized controlled trials. Most of the trials were retrospective studies (n=10). The rate of
uterine rupture after
labor induction was low (n=18, 1.2%). Meta-analysis of studies comparing the risk of
uterine rupture between
labor induction and spontaneous onset of labor found a higher risk after induction (OR 2.45, 95%CI 1.34-4.47, NNH 186). The average rate of
oxytocin application was 68.4%, and vaginal birth was achieved in 56.4%. The risk for cesarean delivery was higher when labor was induced (OR 2.63, 95%CI 2.24-3.10). Data on balloon
catheters for
labor induction after previous
cesarean section are limited by small sample size and retrospective analyses. The present data show a moderately increased risk for
uterine rupture (OR=2.45) compared to spontaneous onset of labor. However, for evidence based recommendations much more well-conducted trials are needed.