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Time from insertion to expulsion of cervical ripening balloon in preterm versus term inductions of labor

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

Preterm induction of labor can be necessary for maternal and fetal wellbeing. Duration of cervical ripening balloon (CRB) use has been studied in only term inductions. Our study investigated duration of time in hours for CRB expulsion and vaginal delivery in preterm inductions of labor.

Methods

This was a single-institution retrospective cohort study of preterm (< 37 weeks) and term (≥ 37 weeks) inductions with CRB between 2010 and 2021. Cesarean deliveries were excluded. Primary outcome was insertion to expulsion time of CRB. Secondary outcomes included induction to delivery time, cervical dilation after expulsion, misoprostol, and Pitocin use. Institutional review board (IRB) approval was obtained prior to the study.

Results

Ninety-eight patients with vaginal delivery after preterm CRB use were identified and matched 1:1 on baseline characteristics (p > 0.05) to term patients with vaginal delivery after CRB use. Mean insertion to expulsion time was significantly shorter for term than preterm inductions (mean 7.2 ± 3.09 h versus 8.5 ± 3.38 h; p < 0.01). Mean induction to delivery time was significantly shorter for term than preterm inductions (18.4 ± 7.6 h versus 22.5 ± 9.01 h; p < 0.01). Increased use of misoprostol, Pitocin, and second CRB were noted among the preterm cohort. Among term patients, more CRB placement at start of induction and greater cervical dilation post-balloon were found in comparison to preterm patients.

Conclusion

Among patients undergoing preterm induction, longer insertion to expulsion time of CRB, longer induction to delivery time, and increased interventions should be expected. Different standards for labor management should be considered for achieving vaginal delivery in preterm inductions.

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Data availability

All data generated or analysed during this study are included in this published article.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, 10012, USA

    Lindsey A. Roth, Elana Kreiger-Benson, Dana R. Gossett & Lisa Shanahan

  2. Department of Population Health, New York University School of Medicine, New York, NY, USA

    Steven Friedman

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  1. Lindsey A. Roth
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  4. Dana R. Gossett
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  5. Lisa Shanahan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by LAR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. LAR: design, planning, conduct, data analysis, manuscript writing; EK-B: data analysis, manuscript writing; SF: data analysis; DRG: design, planning, conduct, data analysis, manuscript writing; LS: design, planning, conduct, data analysis, manuscript writing.

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Correspondence to Lindsey A. Roth.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors declare that they have no conflict of interest.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board of New York University approved this study.

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Patient consent was not required due to the retrospective nature and minimal risk of this study.

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Roth, L.A., Kreiger-Benson, E., Friedman, S. et al. Time from insertion to expulsion of cervical ripening balloon in preterm versus term inductions of labor. Arch Gynecol Obstet 309, 515–521 (2024). https://doi.org/10.1007/s00404-023-06961-6

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  • DOI: https://doi.org/10.1007/s00404-023-06961-6

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