Double-balloon catheter for induction of labour in women with a previous cesarean section, could it be the best choice?
BACKGROUND
We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery.


METHODS
We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score <5), a prior cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value <0.05 was considered statistically significant.


RESULTS
Most women improved their initial Bishop Score (89.5%) although only a 20.8% of them went into spontaneous active labour. Finally, 51.4% of the women achieved a vaginal delivery. Five cases of intrapartum uterine rupture (1.2%) occurred. After multivariate analysis, main risk factors for repeated cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066-2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066-6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959-6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004-1.006). The area under the curve was 0.789 (p < 0.001).


CONCLUSIONS
Double-balloon catheter seems to be safe and effective for cervical ripening in women with a previous cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section.
Hospital Universitario Materno-Infantil Miguel Servet, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain. cdebonrostro@gmail.com.
Carlos
http://orcid.org/0000-0002-8218-1460
C
De Bonrostro Torralba
Department of Obstetrics, Hospital Universitario Materno-Infantil Miguel Servet, Zaragoza, Spain.
Eva Lucía
http://orcid.org/0000-0002-9358-031X
EL
Tejero Cabrejas
Department of Obstetrics, Hospital Universitario Materno-Infantil Miguel Servet, Zaragoza, Spain.
Sabina
http://orcid.org/0000-0002-6767-9084
S
Marti Gamboa
Department of Obstetrics, Hospital Universitario Materno-Infantil Miguel Servet, Zaragoza, Spain.
María
http://orcid.org/0000-0002-3493-3138
M
Lapresta Moros
Department of Obstetrics, Hospital Universitario Materno-Infantil Miguel Servet, Zaragoza, Spain.
Jose Manuel
http://orcid.org/0000-0002-0306-8858
JM
Campillos Maza
Department of Obstetrics, Hospital Universitario Materno-Infantil Miguel Servet, Zaragoza, Spain.
Sergio
http://orcid.org/0000-0002-9048-121X
S
Castán Mateo
D000328:Adult; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D020070:Cervical Ripening / Q000502:physiology*; D002584:Cervix Uteri; D002585:Cesarean Section; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods*; D010121:Oxytocin / Q000008:administration & dosage; D036801:Parturition; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D014597:Uterine Rupture / Q000453:epidemiology; D016064:Vaginal Birth after Cesarean / Q000009:adverse effects; D055815:Young Adult
D010121:Oxytocin
Catheters; Cervical ripening; Induced Labour; Obstetric labour; Trial of labour; Vaginal birth after cesarean