Double-balloon Catheter Research Articles

Double balloon catheter versus vaginal prostaglandins for induction of labor: an observational ambidirectional cohort study

Aim: To compare effectiveness and safety of double balloon catheter and prostaglandins for induction of labor. Methods: an observational ambidirectional cohort study was conducted at a tertiary care university hospital. A total of 666 women with a Bishop score ≤6 requiring labor induction were included. A cohort of 418 patients with double balloon catheter were compared with a retrospective cohort of 248 women induced with prostaglandins, either misoprostol or dinoprostone. Perinatal outcomes were compared between groups, with a p<0.05 considered statistically significant. Results: The cesarean-section rate was 27% in the double balloon group, compared with 27.8% in the prostaglandin group (p=0.352). The mean induction time-to-delivery was longer in the double balloon group as compared to the prostaglandin group (26.6±9.3 hrs vs 19.1±8.6 hrs, p<0.001). Hyperdynamia and umbilical-cord arterial pH<7.1 rates were significantly lower with the mechanical method compared to prostaglandins (p<0.001 and p=0.043, respectively). Other maternal and neonatal outcomes were similar between the groups. Conclusions: Double balloon catheter has similar effectiveness in terms of cesarean-section rate compared to prostaglandins, but with a better safety profile. However, the balloon catheter is associated with a longer time-to-delivery compared to prostaglandins.

Double-balloon catheter vs dinoprostone (PGE-2) insert for labour induction: A meta-analysis of 2493 pregnancies.

Induction of labor (IOL) is the stimulation of the uterus during pregnancy to begin the onset of labour. Nearly two of five pregnancies require IOL. We compared the effectiveness of double-balloon catheter (DBC) with dinoprostone (PGE-2) insert for labour induction from previous studies. We included randomized controlled trials (RCTs) that compared the safety and efficacy of DBC to PGE-2. To evaluate the studies, we utilized the Cochrane tool for risk of bias assessment. The rates of vaginal birth and cesarean section were the primary outcomes. We included ten RCTs in this meta-analysis with a total sample of 2493 singleton pregnancies. After 24 hours, there was no significant difference in the delivery rates between DBC and PGE-2 s [R.R=1.08, 95% CI, (0.77, 1.52), P.value=0.65], and the rate of cesarean delivery [R.R=1.03, 95% CI, (0.90; 1.18), P.value=0.65]. The DBC showed a significantly higher oxytocin use rate compared to the PGE-2 group [R.R=1.77, 95% CI, (1.41; 2.32), P.value<0.0001]. In the PGE-2 group, there was a significantly higher risk of uterine hyperstimulation, tachysystole, and umbilical artery PH levels below 7. There was no significant difference in the efficacy between the PGE-2 and DBC in terms of delivery rate in 24 hours and the rate of cesarean delivery except for a slight BISHOP score improvement with DBC. However, DBC showed a higher rate of oxytocin use compared to the PGE-2, the DBC seems to be safer with a lower risk of umbilical artery PH < 7, uterine hyperstimulation, and tachysystole incidence than PGE-2.

In Reply

Department of Obstetrics and Gynecology, General Obstetrics and Gynecology, Washington University in St. Louis, Center for Outpatient Health, St. Louis, Missouri Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri Guidelines for Letters. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 8 weeks of the article’s publication online. Letters received after 8 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com). Financial Disclosure Shelby M. Dickison disclosed that this article discusses off-label use of the double balloon catheter. Lauren Kus did not report any potential conflicts of interest.

Maternal Morbidity After Double Balloon Catheter Management of Cesarean Scar and Cervical Pregnancies

Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China Guidelines for Letters. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 8 weeks of the article’s publication online. Letters received after 8 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com). Financial Disclosure The authors did not report any potential conflicts of interest. This work was supported by a grant from the Medical Science and Technology Research Fund of Guangdong (NO. A2020244).

Is there a difference in labor patterns after induction with prostaglandins and double-balloon catheters?

Labor progression curves are believed to differ between spontaneous and induced labors. However, data describing labor progression patterns with different modes of induction are insufficient. This study aimed to compare the progress patterns between labors induced with slow-release prostaglandin E2 vaginal analogue and those induced with a double-balloon catheter. This retrospective cohort study included all nulliparous women who delivered at term and who underwent cervical ripening with prostaglandin E2 vaginal analogue or a double-balloon catheter from 2013 to 2021 in a tertiary hospital in Israel. Included in the analysis were women who achieved 10 cm cervical dilatation. The time intervals between centimeter-to-centimeter changes were evaluated. A total of 1087 women were included of whom 786 (72.3%) were induced using prostaglandin E2 vaginal analogue and 301 (27.7%) were induced using a double-balloon catheter. The time from induction to birth was similar between the groups (32.5 hours for the prostaglandin E2 vaginal analogue group [5th-95th percentiles, 6.5-153.8] vs 29.2 hours for the double-balloon group [5th-95th percentiles, 9.1-157.1]; P=.100). The median time of the latent phase (2-6 cm dilation) was longer for the double-balloon catheter group than for the prostaglandin E2 vaginal analogue group (7.3 hours [5th-95th percentiles, 5.6-14.5] vs 6.0 hours [5th-95th percentiles, 2.4-18.8]; P=.042). The median time of active labor (6-10 cm dilatation) was similar between groups (1.9 hours [5th-95th percentiles, 0.3-7.4] for the prostaglandin E2 vaginal analogue group vs 2.3 hours [5th-95th percentiles, 0.3-6.5] for the double-balloon catheter group; P=.307). Deliveries subjected to cervical ripening with a double-balloon catheter were characterized by a slightly longer latent phase than deliveries induced by prostaglandin E2 vaginal analogue. After reaching the active phase of labor, the mode of cervical ripening did not influence the labor progress pattern.

Efficacy and safety of double balloon catheter and dinoprostone for labor induction in multipara at term

PurposeThe aim of this study was to comparatively assess the efficacy and safety of double balloon catheter (DBC) and dinoprostone as labor-inducing agents just for multipara at term.MethodsA retrospective cohort study was conducted among multipara at term with a Bishop score < 6 who needed planned labor induction from January 1, 2020, to December 30, 2020 in Maternal and Child Health Hospital of Hubei province, Tongji Medical College, Huazhong University of Science and Technology. They were divided into DBC group and dinoprostone group, respectively. Baseline maternal data, maternal and neonatal outcomes were recorded for statistical analysis. Total vaginal delivery rate, rate of vaginal delivery within 24 h, rate of uterine hyperstimulation combined with abnormal fetal heart rate(FHR) were regarded as the primary outcome variables. The difference between groups was considered statistically significant when p value < 0.05.ResultsA total of 202 multiparas was included for analysis (95 women in DBC group vs 107 women in dinoprostone group). There were no significant differences in total vaginal delivery rate and rate of vaginal delivery within 24 h between groups. Uterine hyperstimulation combined with abnormal FHR occurred exclusively in dinoprostone group.ConclusionDBC and dinoprostone seem to be equally effective, while, DBC seems to be safer than dinoprostone.

Double Balloon Catheter Tamponade in the Management of Primary Atonic Postpartum Hemorrhage: A Novel Technique in Low Resource Settings

Double Balloon Catheter Tamponade in the Management of Primary Atonic Postpartum Hemorrhage: A Novel Technique in Low Resource Settings

Maternal Morbidity After Double Balloon Catheter Management of Cesarean Scar and Cervical Pregnancies.

We performed a retrospective cohort study of all Type 1 cesarean scar pregnancies (n=18) or cervical pregnancies (n=5) at an academic tertiary center after treatment with a cervical double balloon catheter from 2018 to 2022 to evaluate outcomes and maternal morbidity. Cervical double balloon catheter treatment was associated with no cases (95% confidence interval 0-16%) of maternal hemorrhage treated with transfusion, hysterectomy, or ICU admission. Treatment was successfully performed by nine different obstetrics and gynecology specialists.

Pain and satisfaction in women induced by vaginal dinoprostone, double balloon catheter and oral misoprostol

ObjectiveThe aim of this study was to evaluate the pain experience of women induced by intravaginal dinoprostone (Propess®), oral misoprostol (Angusta®) or double balloon catheter (Cook®). MethodsThis single-center prospective study was carried out in the obstetric gynecology department of the university hospital of Saint-Etienne from March 2018 to April 2021 in women requiring cervical ripening for the purpose of artificial labor induction. ResultsWe included 82 women in the oral misoprostol group, 35 in the vaginal dinoprostone group and 58 in the balloon group. The overall pain, assessed by a numerical scale from 0 to 10, was similar for the different methods of induction (p = 0.253). Pain at insertion was greater with the double balloon catheter compared to the vaginal dinoprostone (3.67 versus 5.75 p = 0.001). Pain in the 2 h prior to the delivery room was greater with vaginal dinoprostone and oral misoprostol compared with the double balloon catheter (7.91 and 7.4 versus 5.47 respectively, p = <0.0001). Women induced by balloon catheter would more often have preferred to be induced by another method compared to those induced by oral misoprostol or vaginal dinoprostone (p = 0.004). Adjusting for previous cesarian section, gestational age at delivery, need for oxytocin augmentation and indication for induction, women induced by balloon were five times more risk to prefer another induction method (OR 5.01 95% CI [1.09–23.03], p = 0.038). There was no significant difference in stress and overall experience of induction depending on the method. ConclusionIn order to improve the women experience, information, consent and participation in the decisions and choices of their induction method are essential.

Comparing the effectiveness and safety of Dinoprostone vaginal insert and double-balloon catheter as cervical ripening treatments in Chinese patients.

BackgroundThis retrospective study was to compare the effectiveness and safety of Dinoprostone vaginal insert vs. double-balloon catheter as cervical ripening agents for labor induction.MethodsPregnant women with Bishop score <7, who received either Dinoprostone vaginal insert 10 mg or Cook's double-balloon catheter for labor induction, were studied. The primary outcome was the rate of vaginal delivery within 48 h; the secondary outcomes were the proportion of women undergoing cesarean section, labor duration, oxytocin administration, changes in Bishop score, complications during labor, and maternal/neonatal outcomes.ResultsOne hundred and eighty-two women were included in Dinoprostone group, and 199 women were in double-balloon catheter group. The rate of vaginal delivery within 48 h was significantly higher in Dinoprostone group than that in double-balloon catheter group (90.11% vs. 75.38%, P = 0.0002). There were 18 cesarean section deliveries (9.89%) in Dinoprostone group and 49 cesarean section deliveries (24.62%) in double-balloon catheter group, with significant differences between two groups (P = 0.0002). The duration of labor was higher in Dinoprostone group, while the augmentation with oxytocin was significantly lower in Dinoprostone group than in double-balloon catheter group (all P < 0.0001). The incidence of chorioamnionitis was significantly higher in double-balloon catheter group as compared with Dinoprostone group (0 vs. 12, P = 0.0005), while neonatal outcomes were similar in two groups.ConclusionDinoprostone vaginal insert as cervical ripening agent is more effective for labor induction and with lower risks of chorioamnionitis as compared with double balloon catheter in Chinese populations.

Safety and efficacy of double-balloon catheter for cervical ripening: a Bayesian network meta-analysis of randomized controlled trials

BackgroundVarious methods are used for cervical ripening during the induction of labor. Mechanical and pharmacological methods are commonly used for cervical ripening. A double-balloon catheter was specifically developed to ripen the cervix and induce labor; however, the efficacy of the double-balloon catheter in cervical ripening compared to other methods is unknown.MethodsWe searched five databases and performed a Bayesian network meta-analysis. Six interventions (double-balloon catheter, Foley catheter, oral misoprostol, vaginal misoprostol, dinoprostone, and double-balloon catheter combined with oral misoprostol) were included in the search. The primary outcomes were cesarean delivery rate and time from intervention-to-birth. The secondary outcomes were as follows: Bishop score increment; achieving a vaginal delivery within 24 h; uterine hyperstimulation with fetal heart rate changes; need for oxytocin augmentation; instrumental delivery; meconium staining; chorioamnionitis; postpartum hemorrhage; low Apgar score; neonatal intensive care unit admission; and arterial pH.ResultsForty-eight randomized controlled trials involving 11,482 pregnant women were identified. The cesarean delivery rates of the cervical ripening with a double-balloon catheter and oral misoprostol, oral misoprostol, and vaginal misoprostol were significantly lower than cervical ripening with a Foley catheter (OR = 0.48, 95% CI: 0.23–0.96; OR = 0.74, 95% CI: 0.58–0.93; and OR = 0.79, 95% CI: 0.64–0.97, respectively; all P < 0.05). The time from intervention-to-birth of vaginal misoprostol was significantly shorter than the other five cervical ripening methods. Vaginal misoprostol and oral misoprostol increased the risk of uterine hyperstimulation with fetal heart rate changes compared to a Foley catheter. A double-balloon catheter with or without oral misoprostol had similar outcomes, including uterine hyperstimulation with fetal heart rate changes compared to a Foley catheter.ConclusionDouble-balloon catheter did not show superiority when compared with other single method in primary and secondary outcomes of labor induction. The combination of double-balloon catheter with oral misoprostol was significantly reduced the rate of cesarean section compared to Foley catheter without increased risk of uterine hyperstimulation with fetal heart rate changes, which was shown in oral or vaginal misoprostol.

Predictors for outcome of induction of labour with double balloon catheter as second-line method after dinoprostone

Predictors for outcome of induction of labour with double balloon catheter as second-line method after dinoprostone

Mechanical cervical ripening for prolonged pregnancies with a previous cesarean section: Double-balloon catheter vs Foley catheter

Introduction: Mechanical cervical ripening methods are considered safer than prostaglandins. Many centers choose this method for pre-induction in pregnant patients with a previous cesarean section. Our objective was to compare efficacy and safety of two different mechanical ripening methods in prolonged pregnancies with a Bishop score ≤ 6 and a previous cesarean section. Methods: Non-randomized study during 6 years in which patients were divided in two cohorts: a first period of time (from November 2014 to November 2018) in which Foley catheter was used and a second period of time (from November 2018 to November 2020) in which double-balloon catheter (Cook® balloon) was the method employed. The same protocol was followed in both groups. Efficacy was defined by the achievement of active labor. Ripening success (changes in Bishop score and achievement of active labor), vaginal delivery rate and maternal and neonatal safety were recorded. Results: The double-balloon was placed in 43 patients and the Foley catheter was inserted in 129 patients. Cook catheter showed better Bishop score difference than Foley but with no statistically significance (3.09 vs 2.76, p=0.271). Active labor was achieved similarly in both groups (81.4% double-balloon vs 78.2% Foley catheter, p=0.726). Although there was a higher vaginal delivery rate in the double-balloon group (62.8%) compared with the Foley group (49.6%), the difference was not statistically significant (p=0.065). Time from catheter insertion to delivery was significantly shorter in the Foley group compared with Cook group (1704 vs 1903 minutes, p&lt;0.05). Newborn weight, umbilical-cord pH, Apgar index and maternal complications were similar in both groups. Conclusion: Mechanical cervical ripening is a safe and effective method in pregnancies with a previous cesarean section. Double-balloon ripening associated higher vaginal delivery rate compared to Foley catheter, but without statistically significant differences.

Analysis of the Application Value of Different Esophagography Techniques in the Diagnosis of H-Type Tracheoesophageal Fistula in Neonates.

Objective The study aimed to analyse the detection rates of the triple-lumen double-balloon catheter technique and conventional esophagography in diagnosing H-type tracheoesophageal fistula (H-TEF) in neonates. Methods The data of 8 neonates diagnosed with H-TEF by surgery in the researchers' hospital between January 2015 and January 2022 were collected. We compared the detection (true positive) rates of H-TEF by the triple-lumen double-balloon catheter technique, conventional esophagography, and multidetector row spiral CT. Results Before surgery, conventional esophagography was applied in all 8 cases, of which the H-TEF diagnosis was confirmed in 5 cases and TEF was suspected in 3 cases. The triple-lumen double-balloon catheter technique was employed in 5 cases, of which 4 were confirmed with H-TEF and 1 was suspected with TEF. Multidetector row spiral CT was performed in 4 cases, and 1 case was confirmed with H-TEF, while no fistula was observed in the other 3 cases. The triple-lumen double-balloon catheter technique yielded a 100% detection rate, while conventional esophagography revealed a 62.5% rate and multidetector row spiral CT showed a 25% rate. By comparative analysis, the true positive rates (TPRs) of the triple-lumen double-balloon catheter technique and conventional esophagography were not significantly different (P=0.118). No significant differences were recorded in TPRs between conventional esophagography and multidetector row spiral CT (P=0.221). However, the triple-lumen double-balloon catheter technique had a significantly higher TPR than multidetector row spiral CT (P=0.118). Conclusion To diagnose congenital H-TEF in neonates, conventional esophagography is a highly valuable yet inconsistently reliable method and the diagnostic value of CT is relatively limited. The triple-lumen double-balloon catheter technique boasts a significantly valuable application for H-TEF diagnosis. Being simple, economical, and effective, it barely requires state-of-the-art facilities, and no complications have occurred during its clinical practice. These advantages justify a possible wider application of the triple-lumen double-balloon catheter technique in clinical practice.

A snapshot of women's and clinicians' perceptions of the double balloon catheter for induction of labor.

INTRODUCTIONInduction of labor (IOL) is rising globally and is growing steadily in the state of New South Wales, Australia. There are numerous methods of induction of labor, including the double balloon catheter (DBC). There is minimal evidence on women’s attitudes and experiences and clinician’s opinions on the use of the DBC. This study aims to explore the views regarding DBC insertion and effectiveness from women induced with a DBC and clinicians involved in the catheter insertion and care.METHODSThis study is a descriptive survey of two prospective, de-identified, self-reported questionnaires which were completed in 2016. One questionnaire was administered to term pregnant women that were admitted to the antenatal ward post IOL, and the other was completed by midwives and obstetric doctors working in the ward at the time.RESULTSThe DBC appeared to be a well-accepted method of cervical ripening among women (61%) and clinicians (>82%). Success of DBC to achieve an artificial rupture of membrane post removal, directly correlates to women’s acceptance (61%). While most clinicians (59–67%) perceived insertion of DBC in an outpatient setting and then women discharged home was appropriate, only 13% of women were in favor. On the logistics of the procedure in respect to insertion and removal of the DBC, there were differences of opinion, with only 43% of women, 77% of midwives and 33% of doctors stating that the timing of insertion and removal needed to be improved.CONCLUSIONSThis study highlights the need to undertake qualitative research to further explore women’s views and perceptions on IOL in order to ensure that clinical practice is woman-centered and evidenced-based, and to guide policy and protocol.

A novel dual balloon rectal catheter for use in the postoperative assessment of low rectal anastomoses following low anterior resection

Following low anterior resection (LAR) of the colon, an image-guided assessment of the anastomosis for leak is typically performed using an enema via a rectal catheter, whether by CT or fluoroscopy. However, there is potential for poor assessment due to inappropriate catheter positioning as well as potential risk that the anastomosis becomes compromised by the balloon inflation. This article discusses the adaptation of a novel double-balloon catheter (originally designed by a member of our institution for use in pediatric intussusception reduction) for assessment of low rectal anastomoses. The goal of this technical note is to demonstrate our experience with this catheter, primarily through example cases, and explain its potential for optimizing colon distension, minimizing improper catheter placement, and potentially reducing the risk of iatrogenic anastomosis disruption.

Deployment of low-profile flow-diverter through a double lumen balloon catheter (remo-diversion technique) to treat recurrent middle cerebral artery bifurcation aneurysm: A technical note.

Wide neck intracranial aneurysms are often difficult to treat with coiling alone, and sophisticated techniques such as balloon-assisted coiling, stent-assisted coiling, flow-diversion, or intrasaccular flow-disruption are sometimes required.This technical note reports the endovascular treatment of a recurrent middle cerebral bifurcation aneurysm by remodeling technique followed by flow-diverter (Silk Vista Baby) deployment through a remodeling balloon (double lumen balloon Eclipse 2L).

Double Balloon Catheter (Plus Oxytocin) versus Dinoprostone Vaginal Insert for Term Rupture of Membranes: A Randomized Controlled Trial (RUBAPRO).

Background: The aim of this study is to demonstrate that a double balloon catheter combined with oxytocin decreases time between induction of labor and delivery (TID) as compared to a vaginal dinoprostone insert in cases of premature rupture of membranes at term. Methods: This is a prospective, randomized, controlled trial including patient undergoing labor induction for PROM at term with an unfavorable cervix in Clermont-Ferrand university hospital. We compared the double balloon catheter over a period of 12 h with adjunction of oxytocin 6 h after catheter insertion versus dinoprostone vaginal insert. After device ablation, cervical ripening continued only with oxytocin. The main outcome was TID. Secondary outcomes concerned delivery mode, as well as maternal and fetal outcome, and were adjusted for parity. Results: 40 patients per group were randomized. Each group had similar baseline characteristics. The study failed to demonstrate reduced TID (16.2 versus 20.2 h, ES = 0.16 (−0.27 to 0.60), p = 0.12) in the catheter group versus dinoprostone except in nulliparous women (17.0 versus 26.5 h, ES = 0.62 (0.10 to 1.14), p = 0.006). The rate of vaginal delivery <24 h significantly increased with combined induction (88.5% versus 66.6%, p = 0.03). No statistical difference was observed concerning caesarean rate (12.5% versus 17.5%, p > 0.05), chorioamnionitis (0% versus 2.5%, p = 1), postpartum endometritis, or maternal or neonatal outcomes. Procedure-related pain and tolerance to devices were found to be similar for the two methods. Interpretation: The double balloon catheter combined with oxytocin is an alternative for cervical ripening in case of PROM at term, and may reduce TID in nulliparous women.

463 Synthetic osmotic dilators dilapan-s vs double balloon catheter ripening of the cervix for induction of labour in nulliparous

Introduction and aim: Two main mechanical methods of cervical ripening are used: insertion of an osmotic dilators or a balloon catheter. Many trials compared mechanical methods to pharmacological. The effects of different balloons have also been evaluated within last years. One trial compared single balloon vs hygroscopic dilators and another one vs Dilapan-S. No trials compared Dilapan-S dilators vs double balloon catheter.We aimed to compare the efficacy and safety of Dilapan-S and double balloon cervical catheters for ripening of the cervix in induction of labour.

Prospective observational study investigating the effectiveness, safety, women's experiences and quality of life at 3 months regarding cervical ripening methods for induction of labor at term-The MATUCOL study protocol.

BackgroundThe purposes of successful induction of labor (IOL) are to shorten the time for IOL to delivery, increase the vaginal delivery rate, and reduce the rate of maternal and neonatal morbidity. In cases of unfavorable cervix (Bishop score <6), cervical ripening is advised to improve vaginal delivery rate. It may be initiated by mechanical (double balloon catheter (DBC), synthetic osmotic dilator) or pharmacologic (prostaglandins) methods, and the problem is complex due to the multitude of cervical ripening methods. We are constantly looking for the optimal protocol of cervical ripening for each woman. The present study aims to elucidate whether cervical ripening method is associated with increase rate of vaginal delivery, good women’s experience and unaltered long-term quality of life after cervical ripening at term regarding maternal and obstetric characteristics.Methods and designThe MATUCOL study is a monocentric, prospective, observational study of all consecutive women who required cervical ripening (Bishop score <6) using different methods (DBC, vaginal dinoprostone, oral misoprostol) with a live fetus at term (≥37 weeks) between January 2020 and August 2021. The outcomes will be mode of delivery, maternal and neonatal morbidity, discomfort/pain assessments during cervical ripening, women’s experience and satisfaction, and the impact of cervical ripening on the health-related quality of life at 3 months. If it reports a significant efficacy/safety/perinatal morbidity/women’s satisfaction/quality of life at 3 months post-delivery associated with a method of cervical ripening in a specific situation (gestational and/or fetal disease) using a multivariate analysis, its use should be reconsidered in clinical practice.DiscussionThis study will reveal that some cervical ripening methods will be more effectiveness, safe, with good women’s experiences and QOL at 3 months compared to others regarding maternal and obstetric characteristics.Trial registrationThis study is being performed at La Roche sur Yon Hospital following registration as GNEDS on January 8, 2020.