Cervical ripening balloon placement for six versus twelve hours: A before and after study

To determine, in women undergoing induction of labor with cervical ripening balloon, whether there is a shorter time to delivery when balloon placement occurs for six versus twelve hours. A before-and-after study was performed after a practice change occurred altering the standard time of cervical ripening balloon placement from twelve to six hours. Data was collected via retrospective electronic chart review. The primary outcome was time from balloon placement to delivery. Secondary outcomes included rates of cesarean delivery and rates of maternal intraamniotic infection. Patients were separated into nulliparous and multiparous cohorts. Kaplan-Meier curves and Cox models were used to compare time to delivery between the groups. From November 2019 to February 2021, 332 patients received cervical ripening via double-balloon catheter. 289 patients were found eligible and 150 were included in final subset analysis. There were 93 nulliparous women, 24 of whom had six hour balloon placement, and 57 multiparous women, 18 of whom at six hour balloon placement. Time, in hours, from cervical ripening balloon placement to delivery was significantly shorter in the six-hour group for both the multiparous cohort (13.3 vs. 27.5, p< 0.001) and the nulliparous cohort (24.7 vs. 29.8, p=0.012). Rates of cesarean delivery were similar across all groups. The study was inadequately powered to detect differences in rates of intraamniotic infections within the groups, due to low incidence. Time from cervical ripening balloon placement to delivery was significantly shorter when balloon was in place for six hours compared to twelve hours in both multiparous and nulliparous patients. Six hour balloon placement was not associated with higher rates of cesarean delivery. Cervical ripening with double-balloon catheter shortens duration of induction of labor and should be standard practice. However, additional studies examing TOLAC and use of other induction agents either before or in concert with cervical ripening balloon are needed.View Large Image Figure ViewerDownload Hi-res image Download (PPT)