Cook Balloon Research Articles

Effectiveness and Safety of the Double Intracervical Balloon vs Dinoprostone in Patients with Previous Cesarean Section.

To compare effectiveness and safety of the Cook's balloon with vaginal dinoprostone to induce labor in patients with previous cesarean section. Observational, and retrospective study that included pregnant women at ≥ 37weeks' gestation, with unfavorable cervix, singleton pregnancy, intact membranes, and a previous cesarean section, who had undergone labor induction in the period 2014-2019. 170 patients (86 balloon-84 dinoprostone) were analyzed. The proportion of women achieving vaginal delivery within 24h was higher in the dinoprostone than in double-balloon group (RR, 3.24; 95% CI, 1.36-7.72). No significant differences were detected in the first 48h in vaginal deliveries (P = .749) or in cesarean section rates (P = .634). Nor were there differences in maternal or fetal safety profiles. A body mass index > 35 increased the risk of cesarean section by 1.53 times (P = .017) and a Bishop's test score < 3 by 1.91 times (P = .009). A vaginal delivery following a cesarean section decreased the probability of another cesarean section by 0.46 times (P = .039). Labor induction with vaginal dinoprostone achieves better vaginal delivery rates in the first 24h vs Cook's balloon. While the difference in uterine rupture rate did not reach significance, this was higher in women receiving prostaglandin.

Misoprostol with balloon vs oxytocin with balloon in high-risk pregnancy induction: a randomized controlled trial

Pregnancies at high risk for maternal, fetal, or placental complications often necessitate induction of labor in the late preterm or early term period for delivery. Limited data exist on the safest method of induction to use in this specific patient population. This study aimed to compare the combination of oxytocin plus a Cook balloon vs misoprostol plus a Cook balloon for induction of labor in high-risk pregnancies. We conducted an open-label, randomized controlled trial at a single institution from July 2020 to May 2022. The study was approved by the institutional review board and registered with ClinicalTrials.gov (NCT04492072). Individuals with a high-risk pregnancy, at least ≥22 weeks' gestation, with a singleton in cephalic presentation, Bishop score ≤6, and intact membranes were offered enrollment. A high-risk pregnancy was defined as a pregnancy with any of the following complications: hypertensive disease of pregnancy, fetal growth restriction, oligohydramnios, suspected placental abruption requiring delivery, uncontrolled pregestational diabetes, or abnormal biophysical profile or nonstress test requiring delivery. The primary outcome was the rate of cesarean delivery. Secondary maternal outcomes included induction to delivery interval, number of vaginal deliveries within 24 hours, rates of uterine tachysystole, intraamniotic infection, operative vaginal delivery, and postpartum hemorrhage. Secondary fetal outcomes included fetal heart rate abnormalities, stillbirth, Apgar scores <7 at 5 minutes, admission to the neonatal intensive care unit, arterial umbilical blood pH <7.1, sepsis, and neonatal death. A subgroup analysis was planned for the primary outcome to assess the different indications for cesarean delivery. An intent-to-treat analysis was performed. During the 22 months of the trial, a total of 150 patients were randomized, and 73 (49%) of those were induced with oxytocin and a Cook balloon and 77 (51%) were induced with misoprostol and a Cook balloon. There was no significant difference in the overall rate of cesarean delivery between the study groups, (21.9% vs 31.1%; relative risk, 0.70; 95% confidence interval, 0.41-1.21), nor among those for which the cesarean delivery was performed for a specific indication. There were no differences in the secondary maternal and fetal or neonatal adverse outcomes. In high-risk pregnancies, the rate of cesarean delivery and adverse maternal and fetal outcomes were similar for induction of labor with oxytocin and a Cook balloon and for induction with misoprostol and a Cook balloon.

Role of mode of induction and delivery and women’s satisfaction after induction of labour at term: An observational study

This cross-sectional study aimed at evaluating the impact of different modalities of induction of labour (IOL) and delivery on levels of woman’ satisfaction. All women aged 18 years or older, who underwent IOL for at-term pregnancy (≥41 weeks of gestation) in randomly selected days during the study period in 6 participating centres were eligible for the study. The questionnaire investigated women’s opinion regarding information about induction, pain control, length of induction, their experience about induction, labour and delivery and their attitude towards induction in a subsequent pregnancy. Women were also asked to fill in the Italian version of the Birth Satisfaction Scale-Revised (BSS-R).A total of 300 women entered the study. The answer to the question about a “positive attitude towards induction in a subsequent pregnancy was “absolutely yes” or “yes” respectively in the 77.8%, 52.8% and 48.6% of women who were induced with oral drugs, vaginal drugs and Cook balloon (heterogeneity chi-square p = 0.05). The corresponding values for women who delivered vaginally or by caesarean section (CS) were 63.3% and 36.4% (chi-square p = 0.0009). The mean BSS-R total score was higher among women who underwent IOL with oral drugs than with vaginal drugs (p < 0.0001) or Cook Balloon (p < 0.0001), and among women who delivered vaginally than in those who delivered by CS (p < 0.0001). Women were asked “What do you think is important for a method of induction?”: 47.3% (95% CI 41.7%-53.0%) of women answered that “should make the induction as painless as possible”, 47.0% (95% CI 41.4%-52.7%) “should induce labour quickly”, 44.3% (95% CI 38.8%-50.0%) “should be safe for baby”.This study showed that vaginal delivery was associated with a higher rate of satisfaction among induced women. Considering mode of induction, oral drugs were associated with a higher level of satisfaction. Control of pain and quick induction were the most appreciated characteristics.

The infection, cervical and perineal lacerations in relation to postpartum hemorrhage following vaginal delivery induced by Cook balloon catheter.

To identify whether infection, cervical laceration and perineal laceration are associated with postpartum hemorrhage in the setting of vaginal delivery induced by Cook balloon catheter. The retrospective study included 362 women who gave birth vaginally at or beyond 37weeks of gestation with a diagnosis of postpartum hemorrhage between February 2021 to May 2022, of which including 216 women with induction of labor (Cook balloon catheter followed by oxytocin or oxytocin) and 146 women with spontaneous delivery. Risk factors for postpartum hemorrhage were collected and compared. 362 women were divided into three groups, group 1 with spontaneous delivery, group 2 with oxytocin, group 3 with Cook balloon catheter followed by oxytocin. There was no significant difference in incidence of infection within three groups (P > 0.05). The rate of cervical laceration and perineal laceration was significantly higher in group 3 compared with groups 2 and 1 (P < 0.05); Multivariate logistic regression analysis found that compared with group 1, either group 3 or group 2 was associated with increased risks of cervical laceration and perineal laceration (P < 0.05), and compared with group 2, group 3 was not associated with increased risks of cervical laceration and perineal laceration (P > 0.05). Infection, cervical laceration and perineal laceration are identified not to be independent risk factors for postpartum hemorrhage for women undergoing labor with Cook balloon catheter; Cervical laceration and perineal laceration increase the risk of postpartum hemorrhage in women with labor induction.

Birthing ball on promoting cervical ripening and its influence on the labor process and the neonatal blood gas index.

BACKGROUNDTerm pregnancy-induced labor refers to the use of artificial methods to induce uterine contractions and terminate pregnancy after 37 wk. It is a common method to prevent overdue pregnancy and to deal with high-risk pregnancies. In addition, it can alleviate maternal complications and cause the fetus to leave the adverse intrauterine environment early, which is beneficial to the outcome of pregnancy.AIMTo explore the effect of a birthing ball on labor by inducing cervical ripening and its influence on labor and the neonatal blood gas index.METHODSTwenty-two women who were scheduled to undergo labor induction and delivery in the obstetrics department of our hospital were randomly divided into two groups: the delivery ball group (childbirth ball combined with COOK balloon induction) and the conventional group (COOK balloon induction alone). The cervical Bishop score before and after intervention, duration of labor at each stage, mode of delivery, neonatal umbilical venous blood pH, oxygen partial pressure (PO2), carbon dioxide partial pressure (PCO2), and the 1-min Apgar score were recorded.RESULTSAfter the intervention, the cervical Bishop score of the delivery ball group (7.84 ± 1.52) was significantly higher than that of the conventional group (7.32 ± 1.29) (P < 0.05), and the cervical Bishop scores of the two groups after intervention were significantly higher than those before intervention (P < 0.05). After the intervention, the first stage of labor (510.9 ± 98.7 min), the second stage of labor (43.0 ± 8.5 min), and the total duration of labor (560.0 ± 120.9 min) in the delivery ball group were lower than those in the routine group, with a first stage of labor of 602.1 ± 133.2 min, a second stage of labor of 48.4 ± 9.1 min, and a total duration of labor of 656.8 ± 148.5 min (P < 0.05). There was no significant difference in the time of the third stage of labor between the two groups (P > 0.05). There was no significant difference in the pH, PO2, and PCO2 values of newborns between the delivery ball group and the conventional group (P > 0.05). The 1-min Apgar score of the delivery ball group was higher than that of the conventional group (9.10 ± 0.38 points vs 8.94 ± 0.31 points, P < 0.05). The natural delivery rate of the delivery ball group was higher than that of the conventional group (91.00% vs 78.00%, P < 0.05).CONCLUSIONThe use of a birthing ball combined with a COOK balloon for inducing labor has a better effect on promoting cervical ripening, shortening the time of labor, and improving the Apgar score of newborns.

Post-hysteroscopy Duration of the Cook Balloon Uterine Stent Effect on the Re-adhesion Formation.

To compare duration of Cook balloon uterine stent on re-adhesions formation, and observe its effect on serum transforming growth factor β1 (TGF-β1) and plasminogen activator inhibitor-1 (PAI-1) levels in patients with intrauterine adhesions (IUA) undergoing hysteroscopic transcervical resection of adhesion (TCRA). Randomised controlled trial. No. 215 Hospital of Shaanxi Nuclear Industry, Shaanxi Province, China, from January 2018 to January 2019. A total of 98 patients with IUA, who underwent hysteroscopic TCRA with cold scissors, were randomly divided into Group A (n=49) and Group B (n=49). Cook balloon uterine stent was placed for 37 days in Group A and 7 days in Group B. Efficacy of two groups was compared. Total effective rate in Group A was higher than that in Group B (p=0.021). After treatment, levels of serum TGF-β1 and PAI-1 in Group A were lower than those in Group B (p <0.001, and p=0.001, respectively). Recurrence rate of IUA at three months after treatment and total incidence of complications in Group A were lower than those in Group B (p=0.012, and 0.037, respectively). Pregnancy rate in the 2-year follow-up period in Group A was higher than that in Group B (p= 0.043). Placement of Cook balloon uterine stent for 37 days after hysteroscopic TCRA in patients with IUA can effectively prevent postoperative intrauterine re-adhesion, have few complications, low recurrence rate of IUA and high re-pregnancy rate, and reduce levels of serum TGF-β1 and PAI-1. Key Words: Intrauterine adhesions (IUA), Transcervical resection of adhesion (TCRA), Transforming growth factor β1 (TGF-β1), Plasminogen activator inhibitor-1 (PAI-1), Pregnancy.

Effectiveness of Dinoprostone and Cook's Balloon for Labor Induction in Primipara Women at Term.

Labor induction is commonly used for achieving successful vaginal delivery. This study aimed to compare the effectiveness of dinoprostone and Cook's balloon as labor-inducing agents in primipara women at term. A retrospective cohort study among primipara women was conducted in Hubei Maternity and Child Health Hospital. Basic clinical characteristics were collected. The main outcomes were vaginal delivery rate, cesarean section rate and forceps delivery rate. Obstetric and perinatal outcomes were also compared. Univariate and multivariate analyses were further performed to evaluate the predictors for vaginal delivery within 24 h. A total of 845 eligible primipara women undergoing labor induction were recruited. Of them, 141 women were induced with dinoprostone (dinoprostone group, DG), and 704 with Cook's balloon (Cook's balloon group, CG). Groups were homogeneous except more women with premature rupture of membranes in DG, with gestational hypertension in CG (P<0.05). The vaginal delivery rate within 12 h was 1.98% and 16.52% in CG and DG respectively (P=0.0001). Besides, the vaginal delivery rate within 24 h was 37.62% and 52.26% in CG and DG respectively (P=0.0079). DG showed the lower rate of oxytocin augmentation, artificial rupture of membrane and postpartum hemorrhage and the shorter interval from insertion to active labor than CG (P<0.05). Multivariate regression analysis revealed that abortion history, oxytocin augmentation, artificial rupture of membrane, and obstetric analgesia were independent predictors for vaginal delivery within 24 h. In conclusion, dinoprostone was more effective than Cook's balloon to induce labor and achieve vaginal birth in the sample of primipara women at term.

Effectiveness and safety of dinoprostona and cook’s balloon for labour induction in pregnants with small for gestational age fetuses

Objectives: To compare the effectiveness (hours until delivery) and safety (rate of vaginal deliveries and caesarean sections, use of oxytocin and perinatal outcomes) of dinoprostone and Cook's balloon as a method of labor induction in pregnant women with fetuses with an estimated weight below the 10th percentile and normal Doppler. Methods: retrospective cohort review of pregnant women with small for gestational age fetuses and induced with both methods in Reina Sofía Hospital, Cordoba, Spain from 2014 to 2018. The main outcome was time until delivery. Descriptive characteristics, obstetric and perinatal outcomes were analyzed. 322 pregnant women were induced: 204 women were induced with Cook's balloon (CB) and 118 with dinoprostone (DIN). RESULTS: Dinoprostone decreases the time until delivery (28.86 vs. 24.32 hours with CB and DIN, respectively, p&lt;0.0001) and the use of oxytocin (79.7% vs 54.2% in CB and DIN group; p&lt;0,01), as compared to Cook's balloon. No differences were observed in the rate of caesarean sections and vaginal deliveries, as well as in perinatal results. Conclusion: DIN reduces the time to delivery compared to CB with a lower need for oxytocin. Moreover, without worse perinatal outcomes.

Application of cook balloon during aorta replacement in a pregnant Marfan-syndrome patient: a case report

BackgroundAortic dissection is a rare and emergent condition. Aortic dissection during pregnancy is not much known but it is quite lethal to both mother and infant. Earlier reports published show that clinicians conducted hysterectomies during cesarean section to avoid anticoagulant-induced uterine bleeding during the following aortic surgery.Case presentationA woman (38, gravida 1, para 0) in the 37th gestational week suffered an acute, severe, sharp pain in the chest and back. She was diagnosed with Standford type A aortic dissection and suspected with Marfan syndrome. An emergency cesarean section was performed immediately to deliver the baby. Since the patient was on anticoagulants during aortic replacement, so Cook balloon was inserted into the uterus to prevent postpartum hemorrhage. This helped to maintain the uterus intact. Family genetic testing showed that the patient was a carrier of FBN1 mutation which was inherited from the patient’s mother, and the newborn also carried the mutation. Hence the patient was concluded to be positive for Marfan syndrome.ConclusionIt is important that clinicians should pay attention to the possibility of aortic dissection in a pregnant woman with chest, abdominal or back pain. In this case study, we employed Cook balloon during cesarean section to avoid anticoagulant-induced uterine bleeding during the following aortic surgery.

The effect of birth ball on the outcome of COOK balloon induction

Objective: To investigate the effect of birth ball on the outcome of COOK balloon induction. Methods: A total of 580 patients were hospitalized in the obstetrics department of Jiaxing Maternal and Child Health Hospital from May 1, 2017 to December 31, 2017. According to the patient's wishes, 290 cases of cervical ripening with birth ball combined with COOK balloon were taken as experimental group, and 290 cases of cervical ripening group with COOK balloon were set as control group. Bishop score improvement, labor time, cesarean section rate, delivery forceps rate, postpartum hemorrhage, and neonatal scores were compared between the two groups of patients. Results: (1)There was no significant difference in the ag, Body Mass Index (BMI), education background, registered residence and gravidity between the two groups (P>0.05). (2)There was no significant difference in Bishop score improvement between the two groups (P>0.05). (3)The labor time in the experimental group (8.4 h±1.5 h)was significantly shorter than that in the control group (10.6 h±2.7 h). The differences were statistically significant (P<0.05). The cesarean section rate (11.03% vs 15.17%), forceps delivery rate (5.52% vs 8.28%), and postpartum hemorrhage (308 ml±9 ml vs 367 ml±16 ml) were significantly lower in the experimental group than in the control group. The differences were statistically significant (P<0.05). Conclusion: The application of the birth ball in the induction of the COOK balloon can shorten the labor time, reduce the cesarean section rate and the forceps delivery rate, and reduce the postpartum hemorrhage, which has certain clinical application value.

Application of uterine lower part breakwater-like suture operation in placenta previa

Objective: To explore the efficacy and safety of uterine lower posterior wall breakwater-like suture technique in controlling the intraoperative bleeding of placenta previa. Methods: From June 2016 to June 2017, 47 patients were diagnosed placenta previa in Union Hospital, Tongji Medical College of Huazhong University of Science and Technology. Posterior wall breakwater-like suture technique was used preferentially, as for cases with poor myometrium layer, lower anterior wall stitch suture was used at the same time. Bilateral descending branches of uterine artery ligation and Cook balloon compression of uterine lower segment was conducted when necessary. The clinic data of the 47 cases were analyzed. Results: Thirty cases (63.8, 30/47) were diagnosed placenta inccreta or percreta by ultrasound or MRI preoperatively. Senventeen cases were diagnosed as placenta accreta (36.2%, 17/47) . Thirty-four cases had the previous history of cesarean section. The average cervical canal length of 47 patients was (2.8±0.9) cm. There were 19 cases (40.4%,19/47) with 1 time posterior wall breakwater-like sutured and 16 cases (34.0%,16/47) with 2 or 3 times posterior wall breakwater-like sutured; 12 cases (25.5%,12/47) were treated with anterior wall stitch suture simultaneously.Ten cases (21.3%, 10/47) underwent uterine artery ligation, 17 cases (36.2%, 17/47) underwent COOK balloon compression on the staxis surface of lower segment. None of them had postpartum hemorrhage or performed internal iliac artery embolization. The median blood loss in the operation was 700 ml, the percentiles 25 was 500 ml, and the percentiles 75 was 1 200 ml. The blood loss ≥1 000 ml in 18 (38.3%, 18/47) patients,and the most serious one was 2 500 ml. The median blood transfusion volume (including allogenetic transfusion and autotransfusion) was 450 ml, the percentiles 25 was 228 ml, and the percentiles 75 was 675 ml. The average vaginal bleeding volume was (150±63) ml first day after operation. The mean hospitalization time was (4.7±1.0) days. The mean gestational weeks of pregnancy termination was (36.1±1.5) weeks, and the mean birth weight of newborns was (2 817±492) g. Apgar score:1-minute 7.8±1.1, 5-minute 8.9±0.8. No neonatal death, 16 cases were transferred to neonatal ICU (34.0%, 16/47) mainly for premature delivery and low birth weight. No complication was found in 6 months post-operation. Conclusions: Uterine posterior wall breakwater-like suture technique is a simple, safe and effective way in controlling intraoperative bleeding of placental previa.Lower anterior wall stitch suture could effectively stop bleeding and restore the normal uterine shape. Combined application of various methods could significantly reduce the incidence of postpartum hemorrhage and hysterectomy, and improve maternal and fetal prognosis.

Comparative Study for Labor Induction with the Foley Catheter and Double Balloon (cook) Catheter in Women with Unfavorable Cervix

Objective: The aim of this study is to compare the efficacy of single- and double-balloon catheters for the induction of labor among women with an unripe cervix. Study design: This prospective randomize interventional study was performed in emergency department of Obstetrics and Gynecology, Zagazig University and ELGALAA maternity hospitals during the period from 6/2017 till 2/2018. In this study (180 patients) who fulfill inclusion and exclusion criteria were enrolled and were divided into two main groups; single and double balloon group. Each group included equal number of prim gravida and multigravida. Result Of 180 pregnant women recruited in this study 160 continued till the end of the study. Pain encountered by using visual analogue scale during the catheter insertion the mean pain perception during catheter insertion was 3.3 ± 2.3 in the Foley catheter group and 3.1 ± 2.47 in the Cook catheter group. In the Foley catheter group there were significantly more spontaneous expulsions of the balloon compared with the Cook balloon group. In the Foley catheter group 82.2% of them delivered vaginally and 17.8% delivered by caesarean section. In cook catheter group 80% of them delivered vaginally and 18% delivered by caesarean section. Regarding maternal complications There were 4 cases of postpartum hemorrhage (PPH), 3 of them were atonic PPH, and only one case with traumatic PPH due to cervical tear in the Cook catheter group and in foley catheter group there were 3 cases of postpartum hemorrhage all of them atonic postpartum. Conclusion: There is significant difference between the two groups regarding Bishop Score after the balloon catheter expulsion or removal and it was significantly higher in the Cook cervical ripening balloon group, but only in the nulliparous group. Putting in mind that the Foley catheter is cheaper than double balloon catheter and at least as effective as Cook catheter or even better, it is recommended to use Foley catheter in induction of labor instead of double balloon catheter.

Multiposition spiral suture of the lower uterine segment: a new technique to control the intraoperative bleeding of pernicious placenta previa

Objective: To explore the efficacy and safety of multiposition spiral suture of the lower uterine segment, a new technique to control the intraoperative bleeding of pernicious placenta previa(PPP). Methods: From May 2014 to May 2015, 38 patients were diagnosed PPP in Tongji Hospital and cesarean sections were performed. After removing the placenta, multiposition spiral suture was used when massive bleeding occurred, and bilateral descending branches of uterine artery ligation was conducted when necessary. Results: 18 of the 38 PPP patients(47%,18/38)were diagnosed placenta accreta. The average cervical canal length of 38 PPP patients was(3.1±0.6)cm. There were 12 cases(32%, 12/38)with 4 regions sutured, 23 cases(61%, 23/38)with 2-3 regions sutured and 3 cases(8%, 3/38)with only posterior wall area sutured. Twelve cases(32%, 12/38)underwent uterine artery ligation, 3 cases(8%, 3/38)underwent uterine artery ligation and COOK balloon. None of them was postpartum hemorrhage or performing internal iliac artery embolization. Two patients received hysterectomy. The average blood loss in the operation was(1 696± 1 397)ml. In 16(42%,16/38)patients, the blood loss exceeded 1 500 ml, and the heaviest one was 4 500 ml. Three patients had haematuria in the first 3 days after the operation. No complication was found in 6 months after the operation. Conclusions: The multiposition spiral suture technique is a simple, safe and effective way to control the massive bleeding in the cesarean section of PPP patients. It is also beneficial for the recovery of the uterus.

Use of the Foley catheter versus a double balloon cervical ripening catheter in pre-induction cervical ripening in postdate primigravidae.

To compare the efficacy of two mechanical devices for pre-induction of labor cervical ripening: the Foley catheter and the Cook cervical ripening balloon. This interventional study included 78 postdate primigravid women randomly allocated into two groups: the Foley or Cook balloon catheter. Removal of the catheters was planned approximately 12 h after insertion if spontaneous expulsion had not occurred. The main outcome measures included changes in Bishop score, insertion to delivery time, mode of delivery and occurrence of adverse effects. Spontaneous expulsion of the Foley catheter was encountered more frequently than the Cook (89.2% vs 78.4%; P = 0.03). However, the median Bishop score was significantly higher when using the Cook compared with the Foley catheter after balloon removal (6 vs 5; P = 0.03). The duration from balloon insertion to expulsion and from insertion to delivery was significantly shorter in the Foley group compared with the Cook balloon group (6:19 ± 2:1 vs 7:26 ± 2:25 h; P = 0.03 and 13:50 ± 4:00 vs 15:16 ± 4:30 h; P = 0.03, respectively). There were no significant differences in other outcomes, such as the amount of oxytocin units used, mode of delivery, pain encountered during or after insertion and overall patient satisfaction. Use of the Cook cervical ripening catheter results in greater cervical ripening compared with the Foley catheter. However, the duration from balloon insertion to expulsion and then delivery were significantly shorter when using the Foley catheter; therefore, we recommend its use, particularly in low resource settings.

Comparison of induction of labor methods for unfavorable cervices in trial of labor after cesarean delivery

Objective: To compare induction of labor methods in patients attempting a trial of labor after cesarean (TOLAC) with an unfavorable cervix.Methods: This is a retrospective cohort study from patients attempting TOLAC from 2009 to 2013. Patients with a simplified Bishop score of three or less where labor was initiated with either a Cook balloon or oxytocin were included. Our primary outcome was mode of delivery. Our secondary outcomes included duration of labor and multiple maternal and neonatal morbidities.Results: Two-hundred and fourteen women met inclusion criteria: 150 received oxytocin and 64 had the Cook balloon placed. The vaginal birth after cesarean delivery rate was significantly higher in the oxytocin group at 70.7% versus 50.0% in the Cook balloon group (p = 0.004). In the multivariable analysis, odds for cesarean delivery were two times higher with the Cook balloon than with oxytocin (Adjusted OR = 2.09, 95% CI = 1.05-4.18, p = 0.036). The duration of labor was longer with the Cook balloon versus oxytocin (21.9 versus 16.3 hours, p = 0.0002). There were no significant differences in maternal and neonatal health outcomes.Conclusion: Oxytocin induction of labor was associated with a higher rate of vaginal delivery and a shorter duration of labor compared to the Cook balloon in women undergoing TOLAC with an unfavorable cervix.

Effects of Cook balloon cervical dilator on full-term nulliparous parturients under epidural analgesia

To explore the feasibility and effects of Cook balloon cervical dilator on full-term nulliparous parturients under epidural analgesia. The observation group(n=40)received Cook balloon cervical dilation under epidural analgesia. However, the control group (n=40) had no epidural analgesia. Latent phase of labor was shorter in observation group than that in control group [(198.7±65.7) vs. (242.9±78.9) min, P<0.05]. And the incidence of cesarean section and perineal laceration was lower under epidural analgesia(8% vs. 15%, 45% vs. 50% respectively). There were no effects on success rate of induced labor in neither group. Cook balloon could shorten latent phase of labor, relieve the pain of parturients and increase no infection rate [leukocyte count: (8.82±2.74) ×109 /L vs. (9.10±3.06) ×109/L, C-reactive protein: (4.73±0.87) mg/L vs. (4.82±0.90) mg/L respectively]. It is worth wider clinical popularization. Key words: Labor, induced; Analgesia, obstetrical

Efficacy and safety of cervical dilatation balloon and Dinoprostone for promoting cervical ripening and induction of labor

Objective To investigate the efficacy and safety of cervical dilatation balloon and Dinoprostone for promoting cervical ripening and induction of labor. Methods 80 maternal who were taken induction of labor were randomly divided into two groups,40 patients in each group,according to the order of admission,the study group and the control group used COOK balloon and Dinoprostone for promoting cervical ripening and induction of labor respectively,Bishop score before and after treatment,cervical ripening rate of maternal and neonatal outcomes were compared between the two groups of maternal. Results The study group's Bishop score was(8.96±0.15)points,which was significantly higher than(6.02±0.34)points of the control group after treatment,the difference was statistically significant(t=3.75,P 0.05). Conclusion The cervical dilatation balloon has a higher success rate for promoting cervical ripening and induction of labor which is safe and reliable that should be widely applied. Key words: Cervical Ripening; Tissue Expansion Devices; Labor,Induced; Dinoprostone

Transcervical Foley’s catheter versus Cook balloon for cervical ripening in stillbirth with a scarred uterus: a randomized controlled trial

Objective: To compare the efficacy and safety of the use of transcervical Foley’s catheter versus Cook cervical ripening balloon in pregnant women with stillbirth, unfavorable cervix and scarred uterus.Design: Randomized controlled study.Setting: El Minia University Hospital, El Minia, Egypt.Patients and methods: Two-hundred pregnant women with stillbirth, unfavorable cervix and scarred uterus were recruited into this study. They were randomized into two groups. In group I (n = 100), cervical ripening was done using Foley’s catheter. In group II (n = 100), cervical ripening was done using Cook cervical ripening balloon.Main outcome measures: Balloon insertion to delivery interval, successful ripening rate, cesarean delivery rate, maternal adverse events and maternal satisfaction.Results: Time from balloon insertion to expulsion and from balloon insertion to delivery was significantly shorter in Foley’s catheter group. However, the difference between the two groups regarding time from balloon insertion to active labor, time from balloon expulsion to delivery, cervical ripening, cesarean section, instrumental delivery, pain score, need for analgesia, hospital stay and maternal satisfaction was not statistically significant.Conclusions: Foley’s catheter and Cook cervical ripening balloon are comparable regarding efficacy and safety profile when used to ripen the cervix in pregnant women with stillbirth, unfavorable cervix and scarred uterus. However, Foley’s catheter has a shorter induction to delivery interval and is relatively cheaper device.

A control study on the COOK balloon catheter, prostaglandin E2 Suppositories and misoprostol in induction of labor at term

Objective To evaluate the effectiveness and safety of Misoprostol,Prostaglandin E2 suppositories and COOK balloon catheter in induction of labor at term.Methods 91 women of full-term pregnancy with indications of induced abortion,and cervical Bishop score ＜6 were randomly divided into Misoprostol group (31 cases),Prostaglandin E2 group (32 cases) and COOK balloon group (28 women).The improvement of cervical conditions was compared before and after the application.The uterine contraction,labor time,fetus delivery method,situation of maternal and newborn were determined.Results The obvious effective rate in Prostaglandin E2 suppositories was 78.6％,in COOK balloon group it was 75.0％,both were significantly higher than those in Misoprostol group.However,the side effect such as placental abruption was found in Prostaglandin E2 group.The cesarean section ratios in the COOK balloon group and the prostaglandin E2 group were much the same,but both were lower than those of the Misoprostol group.Conclusion Although the efficacy of Misoprostol is much weak,it is convenient and cheap.COOK balloon catheter method is the same as prostaglandin E2 in induced labor at term,it is safe and has less side effect. Key words: Misoprostol; Prostaglandin E2; COOK balloon catheter; Induction of labor at term

Cervical ripening using a double balloon device (Cook's balloon): our experience

Objectiveevaluate the efficacy and outcomes of the double balloon device (Cook's balloon) in inducing women into labour in whom prostaglandin has failed or who have had previous cesarean section.MethodData was...