Preinduction Cervical Ripening Research Articles

The Timing of Adverse Events with Foley Catheter Preinduction Cervical Ripening; Implications for Outpatient Use—Podcast #5

The Timing of Adverse Events with Foley Catheter Preinduction Cervical Ripening; Implications for Outpatient Use—Podcast #5

Safety and Efficacy of Oral Mifepristone in Pre-induction Cervical Ripening and Induction of Labour in Prolonged Pregnancy.

To study the safety and efficacy of oral mifepristone in pre-induction cervical ripening and induction of labour in prolonged pregnancy. This is a single blind randomized control trial. 100 women with prolonged pregnancy beyond 40weeks and Bishop score <6 were recruited, and randomly allocated into two groups. Women who received Tab. Mifepristone 200mg orally were assigned in Study Group (n=50) and who received placebo orally were assigned in Control Group (n=50) At the end of 24h, change in the Bishop's score was assessed and Tab. Misoprostol 25μg was administered intravaginally every 4h, maximum 6 doses for induction/augmentation of labour. Analysis regarding safety and efficacy of the drug was done with regards to maternal and perinatal outcome. Among 100 subjects, 50 received mifepristone and 50 received placebo. Mean induction to delivery interval was 1,907±368.4min for Study Group versus 2,079±231.6min for Control Group. The improvement in mean Bishop score was 5.0408±1.90 for Study Group compared with 3.26±1.15 was for Control Group after 24h. Mean dose of misoprostol in Study Group was 40±27.2, while the same in Control Group was 52±19.46. Eight (16%) women in Study Group and two (4%) women in Control Group delivered vaginally within 24h without any need of augmentation. There were 6 (12%) cesareans and 2 (4%) instrumental deliveries in Study Group and 8 (16%) cesareans and 5 (10%) instrumental deliveries in the Control Group. There was no statistically significant difference in perinatal outcomes between two groups. Mifepristone had a modest effect on cervical ripening when given 24h prior to labour induction and appearing to reduce need for misoprostol compared with placebo.

Induction of Labour in Prelabour Rupture of Membranes with or without Cervical Ripening with Prostaglandin E2

Objective: To compare the outcome of induction of labour with titrated dose of oxytocin with or without pre induction cervical ripening using prostaglandin E2.&#x0D; Methods: This is a prospective study. Sixty women with prelabour rupture of membranes (PROM) and Bishops score of less than six were randomly assigned to either immediate induction with intravenous oxytocin drip or induction with intravenous oxytocin drip preceded by cervical priming with prostaglandin E2 (PGE2) gel 0.5mg instilled intracervically. These two groups were compared regarding the mode of delivery, induction to delivery interval and maternal and neonatal morbidities.&#x0D; Results: Cervical priming with PGE2 resulted in lesser number of caesarean section (5 Vs. 12) and lower incidence of meconium stained liquor (n=6 Vs. n=2). Induction to vaginal delivery interval was shorter when cervical priming was done (5.4 hrs Vs 7.9 hrs). The maternal morbidity was negligible (&lt;1%) in both the groups. The number of neonates with birth asphyxia (n=2) and the need for their resuscitation (n=2) was more in the oxytocin group but the need of antibiotics for the neonates was more in PGE2 group (5% Vs. 3%).&#x0D; Conclusion: Induction of labor with oxytocin, with or without cervical priming with vaginal PGE2 gel, are both reasonable options in cases of PROM, since they result in statistically non significant rates of maternal and neonatal morbidities and caesarean section. Cervical priming with prostaglandin results in higher rate of vaginal delivery and shorter induction to vaginal delivery interval and this is viewed as an advantage to the mother.

Pre-induction cervical ripening: comparing between two vaginal preparations of dinoprostone in women with an unfavorable cervix

Objective: Prostaglandin E2 (PGE2-Dinoprostone) is accepted for both ripening of the cervix and induction of labor. As conflicting data exist concerning the efficiency and safety of different treatment modalities, we aimed to compare slow-release vaginal insert PGE2 with serial vaginal tablets of PGE2 for cervical ripening and induction of labor.Methods: A retrospective cohort study comparing all pregnancies who underwent induction of labor by either a single slow-release vaginal insert of 10 mg PGE2 (study group) to a historical control group of women who were treated with serial administration of 3 mg vaginal PGE2 tablets in a 2:1 ratio, matched by parity.Results: Overall, 639 women were enrolled (213 treated with PGE2 tablets and 426 with slow-release vaginal inserts). Vaginal insert was associated with shorter initiation-to-ripening interval (12.4 ± 7.7 versus 18.6 ± 15.2 h, p < 0.001) and a higher rate of delivery within 24 h (61.5 versus 51.6%, p = 0.018). Vaginal insert was associated with an increased rate of tachysystole (8.0 versus 3.1%, p < 0.01); however, the rates of cesarean section or operative delivery due to non-reassuring fetal heart rate (NRFHR) were similar. On multivariable analysis, slow-release vaginal insert was independently associated with a higher rate of delivery within 24 h (OR 1.50, 95% CI 1.04–2.18).Conclusion: Slow-release PGE2 vaginal insert achieves cervical ripening and subsequently delivery over a shorter time period than PGE2 tablets, without increasing uterine hyperstimulation rate.

Randomization of two dosing regimens of vaginal misoprostol for cervical ripening and labor induction in a low resource setting

To compare the effectiveness of two dosing regimens of vaginal misoprostol for cervical ripening and induction of labour. Pregnant women with singleton low risk pregnancy at term scheduled for elective induction of labour were randomized to receive either 25 μg or 50 μg of vaginal misoprostol for pre-labour cervical ripening. All the patients received antenatal care and delivered at the University College Hospital (UCH) from January 1 st to May 31 st 2006. A total of 128 patients were randomized; 65 patients received 25 μg and 63 patients received 50 μg of vaginal misoprostol. Significantly higher number of patients in the 50 μg group progressed to active labour as compared with the 25 μg group (95.2% versus 84.6%, P < 0.05). The need for oxytocin augmentation of labour was higher among the 25 μg as compared with 50 μg (39.7% versus 16.4%, P = 0.007). There was higher proportion of patients in the 50 μg group delivering vaginally within 24 hours as compared with the 25 μg group (98.2% versus 90.0%, P = 0.063). However, the mean interval between the first dose of misoprostol and vaginal delivery was not statistically different in the two groups (754 ± 362 minutes and 885 ± 582 minutes, P = 0.152). The incidence of caesarean section was similar in the two groups (7.7% versus 11%, P = 0.580). Labour complications, such as precipitate labour, tachysystole and abnormal fetal heart rate patterns were greater in the 50 μg group. Twenty-five microgram of misoprostol appears to be as effective as 50 μg for pre-induction cervical ripening and labour induction. Though 50 μg of vaginal misoprostol resulted in relatively faster delivery and less need for oxytocin augmentation, it was associated with more labour complications as compared with 25 μg of misoprostol.

666: Randomized controlled trial: comparing 80mL double versus 30mL single balloon catheters for pre-induction cervical ripening

666: Randomized controlled trial: comparing 80mL double versus 30mL single balloon catheters for pre-induction cervical ripening

The Timing of Adverse Events with Foley Catheter Preinduction Cervical Ripening; Implications for Outpatient Use

We sought to determine the rate and timing of adverse events that occur during preinduction cervical ripening using the Foley catheter before extrusion of the balloon and institution of oxytocin. Using electronic medical records, we identified all women who presented for preinduction cervical ripening using a Foley catheter with a term (≥37 weeks) singleton vertex live fetus from January 1, 2006, to June 14, 2009. Women were excluded if they had had a previous cesarean delivery, gestational hypertension or preeclampsia, pregestational diabetes, rupture of membranes before induction, fetal anomaly, or antepartum stillbirth. Outcomes were cesarean delivery for nonreassuring fetal tracing, vaginal bleeding, placental abruption, or intrapartum stillbirth occurring between 2 hours after Foley catheter placement and 6 am. Among 2,514 women, 1,905 met the inclusion criteria. No adverse outcomes were noted among term, singleton uncomplicated pregnancies receiving a Foley catheter for preinduction cervical ripening who met inclusion criteria (relative risk, 0.0; 95% confidence interval, 0.0-0.002). In a low-risk population, the use of the Foley catheter for preinduction cervical ripening was associated with no adverse outcomes. It appears to be a safe mechanism for cervical ripening and has the potential for use in the outpatient setting in a selected subset of women.

The effect of a Foley catheter balloon on cervical ripening

The Foley catheter balloon may affect cervical ripening through changes in biochemical mediators by immunoassay and immunohistochemistry, when it is used for pre-induction cervical ripening. The aim of the study was to evaluate the changes in the biochemical mediators from the extra-amniotic space and immunohistochemistry in ripened cervical tissue after the insertion of a Foley catheter balloon (FCB) for pre-induction cervical ripening. A total of 18 pregnant women with a Bishop's score < 6, who were undergoing labour induction, were evaluated in this prospective study. The FCB was irrigated with 10 ml of phosphate buffered saline and the irrigant was collected 0, 2, 4 and 8 h after placement of the FCB or until spontaneous expulsion of the FCB occurred. Irrigant specimens were also collected from 10 spontaneous labouring (SL) women in the active phase of labour. The levels of interleukin (IL)-6, IL-8, matrix metalloproteinase (MMP)-8 and NO were measured. Cervical specimens were obtained from 12 women, including four undergoing induction; four SL and four non-pregnant (NP) women. Immunohistochemical staining was performed to localise hyaluronic acid synthase (HAS)-1, IL-6, IL-8, MMP-8, endothelial nitric oxide synthase (eNOS) and inducible NOS (iNOS). Results showed that the levels of IL-6, IL-8, and MMP-8 significantly increased over time in FCB group (p < 0.01). In the immunohistochemical analysis of cervical tissues, immunoreactivity of HAS-1 in the after FCB group was stronger than any of the other groups. The protein expressions of IL-6, IL-8, MMP-8, eNOS and iNOS were more prominent in the after FCB and SL groups than in the NP and the before FCB groups. iNOS was only observed in the after FCB and SL groups. It was concluded that FCB may affect cervical ripening through changes in biochemical mediators by immunoassay and immunohistochemistry, when it is used for pre-induction cervical ripening.

A Randomised Controlled Trial Comparing Intravaginal Misoprostol and Intracervical Dinoprostone in Pre Induction Cervical Ripening

Objective: To compare the efficacy and safety of intravaginal misoprostol with intracervical dinoprostone for preinduction cervical ripening. Material andMethods: It was a randomized controlled trial conducted at department of obstetrics and gynecology, JIPMER, Puducherry. Three hundred women with Bishop score of 6, were assigned randomly to receive either intravaginal misoprostol 25 μg every four hours for four doses, and intracervical dinoprostone gel 0.5 mg every eight hours for two doses. (one hundred women in each group). Oxytocin was initiated as per standardized protocol, if the cervix was favourable. If the cervical ripening was unsuccessful (Bishop score 6) after the maximum doses of drugs in both the groups, then further treatment was individualized. Efficacy and cost of the drugs were compared in both groups. Results: Primary outcome measure was change in Bishop score. Mean Bishop score change at the end of 16 hours was significantly higher in the misoprostol group, (2.57±0.59) compared to dinoprostone group (2.17±0.10, p=0.016). This finding was inspite of the fact that the dinoprostone group had higher Bishop score prior to the ripening.(3.55±0.56 vs 3.28±0.77, p=0.006). Secondary outcome measures such as mean intervention-delivery interval, oxytocin requirement, mode of delivery, maternal and neonatal outcomes were similar in both the groups. Overall mean cost of ripening agent per patient was significantly less in the misoprostol group, (22.56±93.16 rupees) compared to dinoprostone group (493.89±173.99 rupees, p0.0001).Conclusion: Low dose misoprostol is as effective as dinoprostone in cervical ripening and demonstrates similar fetal and maternal safety profile.

Labor induction: comparison between oxytocin and dinoprostone

Labor induction is one of the most frequent procedures in pregnant women. The optimal regimen for preinduction cervical ripening and labor induction is not established. The aim of the present study was to compare the efficacy and safety of vaginal dinoprostone and intravenous oxytocin administration for labor induction. The medical records of the patients who had induction of labor at Okmeydani Teaching and Research Hospital, Department of Obstetrics and Gynecology from January 2010 to June 2011 were evaluated retrospectively. The first group (143 patients) received a single dose of sustained- released dinoprostone 10 mg, which was inserted high into the vaginal fornix. The second group (151 patients) received intravenous oxytocin (synpitan). Maternal and fetal outcomes were compared. There were no significant differences between the two groups for parity, birth weight, fetal gender and mode of delivery. 195 (66.3%) of patiens had vaginal delivery and 99 (33.7%) had cesarean delivery. The median time from start of induction of labor to vaginal birth was longer when a prostaglandin E2 was used for labor induction than it was when oxytocin was used (20.1 hours vs 16.1 hours) (p

326: Induction of labour versus expectant management in women with an unfavourable cervix: caesarean section rates and adverse neonatal outcomes

P 0.39). Time to catheter expulsion was shorter in the Traction Group (1.9 1.5 vs 3.2 2.1 hours, P .001). Change in Bishop and pain scores, cesarean delivery rates, clinical amnionitis, and other maternal morbidities were similar (Table). Subset analyses of those with vaginal delivery, nulliparas, and multiparas revealed similar results. CONCLUSION: Traction on the intracervical Foley catheter during preinduction cervical ripening shortens the time to spontaneous catheter expulsion but does not affect other labor outcomes.

Double-balloon catheter results in higher rate of vaginal delivery within 24 h when compared with dinoprostone vaginal insert

Commentary on: Cromi A, Ghezzi F, Uccella S, et al. Randomised trial of preinduction cervical ripening: dinoprostone vaginal insert versus double-balloon catheter. Am J Obstet Gynecol 2012;207:125.e1–7.[OpenUrl][1] Induction of labour...

The rising trend in caesarean section rates: should we and can we reduce it?

<strong><em>Introduction: </em></strong>The rising caesarean section ( CS) rates in Sri Lanka are causing great concern. <strong><em>Objective: </em></strong>To study whether it would be justified and feasible to attempt reducing the rising caesarean section (CS) rates at the Teaching Hospital, Mahamodara, Galle (THMG). <strong><em>Method: </em></strong>Using the records available at the THMG, the trends in CS rates from 2007-2010 were studied. A prospective audit of CS was carried out in 2010, using a modified version of Robson’s Ten Group Classification of Caesarean Sections. <strong><em>Results: </em></strong>During 2007-2010 the mean CS rate in THMG has significantly increased, and fluctuated between 29.6% and 33.5 %, with no significant changes in perinatal morbidity and mortality, but with a significant increase in the proportion of mothers requiring intensive monitoring and intensive care. In 2010 the CS rates in THMG varied from 44.2% in Unit A, to 31.8% in the Academic Unit and 23.6% in Unit B. The main contributions to the high CS rates in the three units of the THMG were from the categories 5A and 5B (repeat CS), 2B (nulliparous term singleton vertex-NTSV, prior to the onset of labour), 1 (NTSV in spontaneous labour) and 2A (NTSV after induction of labour). The proportions in these categories varied significantly from one unit to another. <strong><em>Conclusions: </em></strong>A detailed analysis of the indications for CS in each group in each of the units is required. The possibility of more nulliparous women and women with only one previous CS scar and no other obstetric complication being carefully selected for a trial of vaginal birth should be explored. The possibility of pre-induction cervical ripening and careful selection of NTSV for induction of labour, and improving intrapartum management and the specificity of diagnosis of antepartum and intrapartum fetal distress needs to be explored. Reducing the high CS rates appears to be justified and feasible in THMG. DOI: <a href="http://dx.doi.org/10.4038/sljog.v34i1.4816">http://dx.doi.org/10.4038/sljog.v34i1.4816</a> <em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2012; <strong>34</strong>: 11-18

A randomized trial of preinduction cervical ripening: dinoprostone vaginal insert versus double-balloon catheter

We sought to compare the efficacy of a double-balloon transcervical catheter to that of a prostaglandin (PG) vaginal insert among women undergoing labor induction. In all, 210 women with a Bishop score ≤6 were assigned randomly to cervical ripening with either a double-balloon device or a PGE2 sustained-release vaginal insert. Primary outcome was vaginal delivery within 24 hours. The proportion of women who achieved vaginal delivery in 24 hours was higher in the double-balloon group than in the PGE2 group (68.6% vs 49.5%; odds ratio, 2.22; 95% confidence interval, 1.26-3.91). There was no difference in cesarean delivery rates (23.8% vs 26.2%; odds ratio, 0.88; 95% confidence interval, 0.47-1.65). Oxytocin and epidural analgesia were administered more frequently when a double-balloon device was used. Uterine tachysystole or hypertonus occurred more frequently in the PGE2 arm (9.7% vs 0%, P = .0007). The use of a double-balloon catheter for cervical ripening is associated with a higher rate of vaginal birth within 24 hours compared with a PGE2 vaginal insert.

Comparison of the Efficacy of Foley Catheter Balloon with Dinoprostone Gel for Cervical Ripening at Term

Objective: The purpose of this study was to compare the efficacy of extra-amniotic Foley catheter with intra cervical Dinoprostone gel for preinduction cervical ripening. Study Design: A randomized, prospective study was conducted in the Department of Obstetrics and Gynecology, PGIMS Rohtak on 100 pregnant women admitted for induction of labor. Fifty patients were randomized to receive Dinoprostone gel and 50 patients to receive intracervical, extra-amniotic Foley catheter. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (4.18 ± 1.81 and 4.6 ± 1.48 respectively, p < 0.001); however, there was no significant difference between the groups. Mean duration of induction to delivery was 18.51 ± 8.52 in Foley catheter group and 18.21 ± 11.13 in prostaglandin group, the difference being statistically insignificant. Among 50 cases of prostaglandin only single dose was sufficient for 23 (46%) cases to induce labor. But in 27 (54%) cases 2nd dose of prostaglandin were required. The expenditure of intervention showed that Rs. 325 were required for induction by prostaglandin as compared to Rs. 60/- for Induction by Foley’s catheter and the difference was highly significant statistically There was no difference between the groups in mode of delivery, infant weight, apgar score and intrapartum complications. Conclusion: In conclusion, although both Foley catheter and dinoprostone gel appear to be effective agents for cervical ripening. Foley catheter causes less fetal distress, cheap and safety profile of Foley catheter is such that it can be used on an out patient basis, but not dinoprostone gel. These results make Foley catheter comparable or even superior to dinoprostone gel for cervical ripening specially in developing countries.

Clinical parameters for prediction of successful labor induction after application of intravaginal dinoprostone in nulliparous Chinese women.

SummaryBackgroundThe aim of this study was to compare the possible clinical parameters for prediction of successful labor induction in Chinese nulliparous women.Material/MethodsA retrospective, observational trial of labor induction was performed, using a single dose of 10 mg controlled-release dinoprostone for preinduction cervical ripening in 127 nulliparous women (gestational age 38–42 weeks, singleton cephalic presentation). The characteristics of the women with successful labor induction (defined as vaginal delivery achieved on the day of admission; n=80) and failed labor induction (n=47) were compared.ResultsThe main differences observed between the groups were gravidity (P<0.05), induction-active labor interval (5.16±2.98 vs. 8.40±3.41; P<0.05) and birth weight (3421.11±368.14 vs. 3566.36±345.16; P<0.05). Logistic regression demonstrated that gravidity (P<0.05) and induction-active labor interval (P<0.05), but not Bishop score, were significant and independent contributing factors for successful labor induction. In the receiver operating characteristic curves for the prediction of successful labor induction, the best cut-off value for gravidity was 3 (95% confidence interval [CI] 0.64–0.83, P=0.000), and the best cut-off value for the induction-active labor interval was 7.96 (95%CI 0.66–0.85, P=0.000).ConclusionsLess gravidity and shorter induction-active labor interval predict successful labor induction with reasonable accuracy.

The efficacy of two different doses of vaginal isosorbide mononitrate in pre induction cervical ripening: a double blind randomised controlled trial

Nitric oxide donors have been shown to cause cervical ripening. The aim of this study was to evaluate the effects on the mother and the fetus when isosorbide mononitrate (ISMN) 40 mg or the sustained release ISMN (ISMN - SR) 60 mg was administered vaginally for preinduction cervical ripening. A double blind randomised controlled trial. Consecutive women (n=156) with uncomplicated singleton pregnancies between 40 weeks +5 days and 41 weeks' gestation with modified Bishop Scores (MBS) <5 were allocated by stratified (primp/multip) block randomisation to receive ISMN 40 mg, ISMN - SR 60 mg or the placebo vitamin C 100 mg vaginally. At the commencement of the study the parity and mean age, MBS, pulse rate (PR), systolic and diastolic blood pressure (SBP and DBP), umbilical artery resistance index (RI) and pulsatility index (PI) were similar among the three treatment groups. There was significant increase (p<0.001) of mean MBS by 1.3 (95% CI 0.8, 1.7) in primips and by 1.7 (95% CI 1.3, 2.0) in multips at 6 hours and by 2.4 (95% CI 1.9, 2.7 ) in primips and by 2.3 (95% CI 2.0, 2.6) in multips at 48 hours. Greater proportions of primips (42% with ISMN - SR 60 mg and 31% with ISMN 40 mg, p<0.05) were favourable for induction of labour (IOL) after 48 hours in comparison with the controls (7.6%). Greater proportions of multips (46% with ISMN - SR 60 mg and 40% with ISMN 40 mg, p<0.05) were favourable for IOL after 48 hours in comparison with the controls (16%). A mean increase of PR by 6.7-10.2 bpm (95% CI 5.0 - 12.5, p<0.001) in both ISMN groups at 180 minutes persisted up to 360 minutes. A mean reduction of SBP by 7.3 - 10 mmHg (95% CI = 8.0-11.5, p<0.001) in both ISMN groups at 180 minutes persisted up to 360 mins. No significant change was seen in DBP, RI or PI. Frequency of maternal side effects (mainly headache) were higher in ISMN groups. When compared with the placebo Vitamin C 100 mg, vaginal ISMN 40 mg and ISMN - SR 60 mg lead to significantly greater cervical ripening after 6 hours and 48 hours respectively. Therefore vaginal ISMN leads to more women becoming favourable for IOL. Vaginal ISMN does not affect placental blood flow but causes headaches and clinically insignificant maternal haemodynamic changes.

Comparative Study of Intra-cervical Foley’s Catheter and PGE2 Gel for Pre-induction Ripening (Cervical)

The success of induction of labor depends on the cervical status at the time of induction. For effective cervical ripening both Foley's catheter and PGE(2) gel are used. The aim of this study was to compare the efficacy of intra cervical Foley's catheter and intra cervical PGE(2) gel in cervical ripening for the successful induction of labor. A randomized, prospective study was conducted in the Dept of OBGY, GMCH, Aurangabad from July 2005-January 2008. 400 patients at term with a Bishop's score ≤3 with various indications for induction were randomly allocated to receive (200 pts) intra-cervical Foley's catheter or PGE(2) gel (200 pts). After 6h post induction, Bishop's score was noted labor was augmented if required. Statistical analysis was done using Chi square test and t test. The groups were comparable with respect to maternal age, gestation age, indication of induction and initial Bishop's score. Both the groups showed significant change in the Bishop's score, 5.56±1.89 and 5.49±1.82 for Foley's catheter and PGE(2) gel, respectively, P<0.001; However there was no significant difference between the two groups. There was no significant difference in the side effects. Twenty eight cesarean sections (14%) were performed in Group A and 37 (18.5%) were performed in Group B (not significant). The induction to delivery interval was 15.32±5.24h in Group A and 14.2±5.14h in Group B (P=0.291). Apgar scores, birth weights and NICU admissions showed no difference between the two groups. This study shows that both Foley's Catheter and PGE(2) gel are equally effective in pre induction cervical ripening.

Comparison between sonographic cervical length and Bishop score in preinduction cervical assessment: a randomized trial

To compare sonographically measured cervical length with the Bishop score in determining the requirement for prostaglandin administration for preinduction cervical ripening in nulliparae at term. One hundred and fifty-four women with singleton pregnancies at term who were scheduled for induction of labor were randomly assigned to receive prostaglandin for preinduction cervical ripening based on the Bishop score or sonographic cervical length. A cervix unfavorable for treatment with prostaglandin for preinduction cervical ripening was defined as having either a Bishop score of ≤ 4 or a cervical length of ≥ 28 mm. The primary outcome measures were induction success (defined as an ability to achieve the active phase of labor) and the percentage of patients treated with prostaglandin for preinduction cervical ripening. The two groups were similar with respect to maternal demographics, gestational age, cervical length, and Bishop score. The rates of induction success and Cesarean delivery, the interval to active phase of labor, and the interval to delivery were also similar in the two groups. However, in the transvaginal ultrasound group (n = 77), prostaglandin was administered to only 36% of the nulliparae compared with 75% of those in the Bishop score group (n = 77) (P < 0.0001). In comparison with the Bishop score, the use of sonographic cervical length for assessing the cervix prior to induction of labor can reduce the need for prostaglandin administration by approximately 50% without adversely affecting the outcome of induction in nulliparae at term if the cut-off values used are a Bishop score of ≤ 4 and a cervical length of ≥ 28 mm.

Extra-amniotic balloon for preinduction cervical ripening: a randomized comparison of weighted traction versus unweighted

Objective: To determine whether a weighted versus unweighted balloon catheter achieved a shorter first stage of labor. Methods: This was a randomized trial of patients undergoing induction with Bishop score <4. Women were randomized to weighted balloon catheter with 1000 mL fluid bag or unweighted catheter taped to the thigh. Results: A total of 60 women were randomized. The time from balloon catheter insertion until discontinuation was significantly longer in the unweighted group 4.62 ± 0.65 h versus 1.59 ± 0.2 h in the weighted group (p = 0.001). This resulted in longer cervical ripening/first stage of labor in the unweighted (18.52 ± 0.96 h) versus weighted group (15.3 ± 0.99 h) (p = 0.025). The unweighted balloon catheter had a shorter first stage of labor as gravidity increased (p = 0.007) and as race went from white to non-white (p = 0.003). There was no difference in perceived pain after balloon insertion (p = 0.0942), or Bishop score after balloon discontinuation (p = 0.1661). Conclusion: The total time from cervical ripening to the end of the first stage of labor is significantly shortened with the weighted balloon catheter.