[Double-balloon catheter compared to vaginal dinoprostone for cervical ripening in obese women at term]

Abstract

Objective: To compare the efficacy of a double-balloon catheter versus vaginal prostaglandin E2 (dinoprostone) for cervical ripening in obese patients with unfavorable cervix at term.

Methods: The study had an open-label, prospective combined with retrospective, observational design. From January 2013 until May 2016, a prospective cohort study of 46 women with pre-pregnancy BMI>30kg/m², live singleton term fetuses (>37 weeks) in vertex presentation and unfavorable cervix (Bishop score<6), who underwent labor induction for conventional indications using a double-balloon catheter. In the same period, 46 obese women who had undergone cervical ripening using vaginal dinoprostone (3mg) were retrospectively included. Women in groups were paired according to Bishop score before the insertion, pre-pregnancy BMI and parity. The primary outcome was a favorable cervix (Bishop score ≥6) 24h after cervical ripening.

Results: After 24h, there was a significantly higher rate of women with favorable cervix (Bishop score ≥6) in the double-balloon group than in dinoprostone group (80.4% vs 47.8%; P=0.001). After adjustment, a double-balloon catheter was significantly associated with an efficient cervical ripening compared to vaginal dinoprostone (aOR 7.81, 95% CI 2.58-23.60). No difference was observed in cesarean section rate (39.1% in each group; P=0.96) and in mean induction time to vaginal delivery (34.5h in the balloon group vs 36.5h in the dinoprostone group; P=0.53). Maternal and neonatal outcomes were similar.

Conclusion: For obese patients at term, cervical ripening using a double-balloon catheter is more efficient on Bishop score after 24h compared to vaginal dinoprostone.

Keywords: Cervical ripening; Cesarean section; Césarienne; Double ballonnet; Double-balloon; Déclenchement artificiel du travail; Induction mécanique; Maturation cervicale; Mechanical labor induction; Obesity; Obésité.