Predictors of vaginal delivery after cervical priming using a double balloon catheter
DOI:
https://doi.org/10.12809/hkjgom.25.1.381Keywords:
Labor, induced, Fetal growth retardation, Vaginal birth after cesareanAbstract
Objective: To determine predictors of successful vaginal delivery after induction of labour using a double balloon catheter.
Methods: Medical records of women who underwent induction of labour using a double balloon catheter between 1 September 2017 and 31 August 2024 at a tertiary public hospital in Hong Kong were retrospectively reviewed.
Results: Of 111 women, 32 (28.8%) had a scarred uterus secondary to a previous Caesarean section or a myomectomy, 53 (47.7%) had failed pharmacological priming, and 26 (23.4%) had a contraindication for pharmacological priming. The latter group had lower body mass index and gestational age and comprised most cases of fetal growth restriction. In total, 106 (95.5%) women had successful cervical priming. Subsequently, 56 (50.5%) had vaginal deliveries and 55 (49.5%) underwent Caesarean sections. The rate of vaginal delivery was higher in women with a contraindication of pharmacological priming, compared with women with a scarred uterus and women who failed pharmacological priming (73.1% vs 50.0% vs 39.6%, p=0.02). Predictors of successful vaginal delivery after the use of a double balloon catheter were a body mass index of <30 kg/m2 (adjusted odds ratio [aOR]=3.102, p=0.019), a history of vaginal delivery (aOR=4.081, p=0.026), and a cervix with an initial modified Bishop score of ≥4 (aOR=4.488, p=0.045). However, larger uterine or vaginal balloon volumes were not associated with higher vaginal delivery rates.
Conclusion: Predictors of vaginal delivery after induction of labour using a double balloon catheter were a non-obese status, a history of vaginal delivery, and a favourable cervical status.
References
1. Du YM, Zhu LY, Cui LN, Jin BH, Ou JL. Double-balloon catheter versus prostaglandin E2 for cervical ripening and labour induction: a systematic review and meta-analysis of randomised controlled trials. BJOG 2017;124:891-9.
2. Royal College of Obstetricians and Gynaecologists. Birth After Previous Caesarean Birth. Green-top guideline No. 45. Accessed 6 November 2024. Available from: https://www.rcog.org.uk/media/kpkjwd5h/gtg_45.pdf.
3. Morris RK, Johnstone E, Lees C, Morton V, Smith G; Royal College of Obstetricians and Gynaecologists. Investigation and care of a small-for-gestational-age fetus and a growth restricted fetus (Green-top Guideline No. 31). BJOG 2024;131:e31-e80.
4. Familiari A, Khalil A, Rizzo G, et al. Adverse intrapartum outcome in pregnancies complicated by small for gestational age and late fetal growth restriction undergoing induction of labor with Dinoprostone, Misoprostol or mechanical methods: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020;252:455-67.
5. National Institute for Health and Care Excellence. Insertion of a double balloon catheter for induction of labour in pregnant women without previous caesarean section. Accessed 6 November 2024. Available from: https://www.nice.org.uk/guidance/ipg528/resources/insertion-of-a-double-balloon-catheter-for-induction-of-labour-in-pregnant-women-without-previous-caesarean-section-pdf-1899871812579013.
6. Waldron S, Contziu H, Aleshin O, Phipps H. A snapshot of women’s and clinicians’ perceptions of the double balloon catheter for induction of labor. Eur J Midwifery 2022;6:33.
7. Tam HM, Shu W. Predictors for outcome of induction of labour with double balloon catheter as second-line method after dinoprostone. Hong Kong J Gynaecol Obstet Midwifery 2022;22:81-6.
8. Berndl A, El-Chaar D, Murphy K, McDonald S. Does cervical ripening at term using a high volume foley catheter result in a lower caesarean section rate than a low volume foley catheter? A systematic review and meta-analysis. J Obstet Gynaecol Can 2014;36:678-87.
9. Dinarello CA, Porat R. Chapter 23: Fever. In: Harrison’s Principles of Internal Medicine, 19th ed.
10. Bjorklund J, Wiberg-Itzel E, Wallstrom T. Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study. PLoS One 2022;17:e0263685.
11. Wang J, Cao Y, Chen L, Tao Y, Huang H, Miao C. Influence factor analysis and prediction model of successful application of high-volume Foley Catheter for labor induction. BMC Pregnancy Childbirth 2023;23:776.
12. Obeidat RA, Almaaitah M, Ben-Sadon A, et al. Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan. BMC Pregnancy Childbirth 2021;21:685.
13. Vital M, Grange J, Le Thuaut A, Dimet J, Ducarme G. Predictive factors for successful cervical ripening using a double‐balloon catheter after previous cesarean delivery. Int J Gynecol Obstet 2018;142:288-94.
14. Boisen AB, Løkkegaard EC, Fuglsang J. Double-balloon catheter for induction of labor in 362 women with and without prior cesarean section. Eur J Obstet Gynecol Reprod Biol X 2019;4:100033.
15. Ellis JA, Brown CM, Barger B, Carlson NS. Influence of maternal obesity on labor induction: a systematic review and meta-analysis. J Midwifery Womens Health 2019;64:55-67.
16. Kehl S, Weiss C, Rath W. Balloon catheters for induction of labor at term after previous cesarean section: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016;204:44-50.
17. Cañadas JV, González MT, Limón NP, et al. Intracervical double-balloon catheter versus dinoprostone for cervical ripening in labor induction in pregnancies with a high risk of uterine hyperstimulation. Arch Gynecol Obstet 2021;304:1475-84.
18. Haavisto H, Polo-Kantola P, Anttila E, Kolari T, Ojala E, Rinne K. Experiences of induction of labor with a catheter: a prospective randomized controlled trial comparing the outpatient and inpatient setting. Acta Obstet Gynecol Scand 2021;100:410-7.
19. Dombrovsky I, Roloff K, Okekpe CC, Stowe R, Valenzuela GJ. Patient pain and satisfaction with 10, 30, and 70 mL transcervical foley balloons for cervical ripening during induction of labor. Cureus 2023;15:e41535.
20. Salim R, Zafran N, Nachum Z, Garmi G, Kraiem N, Shalev E. Single-balloon compared with double-balloon catheters for induction of labor: a randomized controlled trial. Obstet Gynecol 2011;118:79-86.
21. Yamada T, Kataoka S, Takeda M, et al. Umbilical cord presentation after use of a trans-cervical balloon catheter. J Obstet Gynaecol Res 2013;39:658-62.
22. Salomon LJ, Alfirevic Z, Da Silva Costa F, et al. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound Obstet Gynecol 2019;53:715-23.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Hong Kong Journal of Gynaecology, Obstetrics and Midwifery
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The Journal has a fully Open Access policy and publishes all articles under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. For any use other than that permitted by this license, written permission must be obtained from the Journal.
