title: Timing of sequential use of double-balloon catheter and oral misoprostol for induction of labor.
abstract: OBJECTIVE
  The best time to commence cervical ripening with a balloon catheter is unknown. The aim of this study was to evaluate whether application of a balloon catheter in the morning or in the evening is better when sequential prostaglandin application is planned.
  
  
  METHODS
  This multicenter historical cohort study included 415 women with an unfavorable cervix undergoing labor induction at term. Labor was induced with a double-balloon catheter and the sequential use of oral misoprostol if necessary. The balloon catheter was placed in the morning group between 02:00-15:00 and in the evening group between 15:00-02:00. The primary outcome measure was the cesarean section rate. Secondary outcome measures included failed labor induction (no vaginal delivery within 72 h).
  
  
  RESULTS
  The cesarean section rate did not differ between the groups (morning 26.9%, evening 24.3%; P = 0.5553); however, more women in the morning group did not deliver within 72 h (8.8% vs 3.1%; P = 0.0138). In nulliparous women, labor induction failed more often in the morning group (12% vs. 4%, P = 0.043). In parous women, the induction-to-delivery interval was longer in the morning group (1756 vs. 1349 min; P = 0.046), and there were fewer deliveries within 24 h (35% vs. 56%, P = 0.016).
  
  
  CONCLUSIONS
  When sequential use of a double-balloon catheter and oral misoprostol for labor induction is planned, the preferable time for catheter placement is in the evening. This resulted in fewer failed inductions in nulliparous women and a shorter induction-to-delivery interval and more deliveries within 24 h in parous women.
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Germany. sven.kehl@gmail.com.
authors.forename: Sven
authors.initials: S
authors.lastname: Kehl
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Böhm
authors.affiliation: Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Germany.
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Germany.
authors.forename: Jutta
authors.initials: J
authors.lastname: Heimrich
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Dammer
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Germany.
authors.forename: Friederike
authors.initials: F
authors.lastname: Baier
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Sütterlin
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Germany.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Faschingbauer
mesh_terms: D000284:Administration, Oral; D000328:Adult; D002404:Catheterization / Q000379:methods*; D020070:Cervical Ripening / Q000187:drug effects; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D016595:Misoprostol / Q000008:administration & dosage*; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D013997:Time Factors
chemical_list: D016595:Misoprostol
keywords: balloon catheter; delivery; induction of labor; misoprostol; sequential use; timing