Cochrane review: little difference in time to delivery with balloon vs pharmacologic methods

  • de Vaan MD & al.
  • Cochrane Database Syst Rev
  • 18.10.2019

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Times to delivery differ little between balloon vs pharmacologic medication for induction of labor (IOL), according to this Cochrane review.
  • Reduced risk for uterine hyperstimulation is seen with balloon.

Why this matters

  • Induction increases hospitalization time and time to delivery.

Key results

  • Balloon vs prostaglandin (PGE2):
    • Rate of vaginal delivery not achieved within 24 hours is not significantly different.
  • Balloon vs low-dose vaginal misoprostol:
    • Balloon catheter reduces risk for hyperstimulation.
  • Balloon vs low-dose oral misoprostol:
    • Rate of vaginal delivery not achieved within 24 hours is slightly higher with balloon.

Study design

  • Systematic review.
  • Clinical trials comparing methods for cervical ripening or IOL were included (113 trials; 22,373 participants).
  • Primary outcomes included vaginal deliveries not achieved within 24 hours and uterine hyperstimulation with fetal heart rate abnormalities.
  • Safety was examined using numerous measures.
  • Mechanical methods: defined as balloon, laminaria, Dilapan, injected fluid in the extra-amniotic space.
  • Pharmacological methods: defined as PGE2 and low-dose misoprostol.
  • Balloon: defined as Foley or "Atad" (double balloon or Cook catheter).
  • Funding: University of Geneva; Netherlands Organisation for Scientific Research.

Limitations

  • This review defines a balloon catheter as a "mechanical method," but its main function may be the release of prostaglandins.