Is there a difference in labor patterns after induction with prostaglandins and double-balloon catheters?

Hila Shalev-Ram; Roi Cirkin; Gal Cohen; Shai Ram; Yoram Louzoun; Michal Kovo; Tal Biron-Shental

doi:10.1016/j.xagr.2023.100198

Is there a difference in labor patterns after induction with prostaglandins and double-balloon catheters?

AJOG Glob Rep. 2023 Mar 10;3(3):100198. doi: 10.1016/j.xagr.2023.100198. eCollection 2023 Aug.

Authors

Hila Shalev-Ram^{1

2

3}, Roi Cirkin⁴, Gal Cohen^{1

2}, Shai Ram², Yoram Louzoun⁴, Michal Kovo^{1

2}, Tal Biron-Shental^{1

2}

Affiliations

¹ Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel (Drs Shalev-Ram, Cohen, Kovo, and Biron-Shental).
² Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Shalev-Ram, Cohen, Ram, Kovo, and Biron-Shental).
³ Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel (Dr Ram).
⁴ Department of Mathematics, Bar Ilan University, Ramat Gan, Israel (Drs Cirkin and Louzoun).

Abstract

Background: Labor progression curves are believed to differ between spontaneous and induced labors. However, data describing labor progression patterns with different modes of induction are insufficient.

Objective: This study aimed to compare the progress patterns between labors induced with slow-release prostaglandin E₂ vaginal analogue and those induced with a double-balloon catheter.

Study design: This retrospective cohort study included all nulliparous women who delivered at term and who underwent cervical ripening with prostaglandin E₂ vaginal analogue or a double-balloon catheter from 2013 to 2021 in a tertiary hospital in Israel. Included in the analysis were women who achieved 10 cm cervical dilatation. The time intervals between centimeter-to-centimeter changes were evaluated.

Results: A total of 1087 women were included of whom 786 (72.3%) were induced using prostaglandin E₂ vaginal analogue and 301 (27.7%) were induced using a double-balloon catheter. The time from induction to birth was similar between the groups (32.5 hours for the prostaglandin E₂ vaginal analogue group [5th-95th percentiles, 6.5-153.8] vs 29.2 hours for the double-balloon group [5th-95th percentiles, 9.1-157.1]; P=.100). The median time of the latent phase (2-6 cm dilation) was longer for the double-balloon catheter group than for the prostaglandin E₂ vaginal analogue group (7.3 hours [5th-95th percentiles, 5.6-14.5] vs 6.0 hours [5th-95th percentiles, 2.4-18.8]; P=.042). The median time of active labor (6-10 cm dilatation) was similar between groups (1.9 hours [5th-95th percentiles, 0.3-7.4] for the prostaglandin E₂ vaginal analogue group vs 2.3 hours [5th-95th percentiles, 0.3-6.5] for the double-balloon catheter group; P=.307).

Conclusion: Deliveries subjected to cervical ripening with a double-balloon catheter were characterized by a slightly longer latent phase than deliveries induced by prostaglandin E₂ vaginal analogue. After reaching the active phase of labor, the mode of cervical ripening did not influence the labor progress pattern.

Keywords: Propess; active phase; double-balloon catheter; induction of labor; labor curve; latent phase; partogram.