1. There was no significant difference between groups in terms of rate of caesarean delivery, caesarean delivery for failure to progress, and caesarean delivery for fetal distress.

2. Adverse perinatal outcomes were lower in the balloon catheter group versus vaginal prostaglandin group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Induction of labour is an obstetrical procedure that is becoming more commonly performed worldwide. Many studies suggest that balloon catheters may be equally effective as prostaglandin E2 (PGE2) inhibitors for cervical ripening; however, the evidence to date has remained controversial. This meta-analysis aimed to compare the safety and efficacy of balloon catheters versus vaginal prostaglandins for cervical ripening prior to labour induction. Key primary outcomes included caesarean delivery, indication for caesarean delivery, and composites for adverse maternal and perinatal outcomes. According to study results, no significant difference was noted between balloon catheters and vaginal prostaglandins concerning rate of caesarean delivery and maternal safety. However, patients who received the balloon catheter intervention were reported to have a lower rate of adverse perinatal outcomes, such as low arterial umbilical cord pH. This study was strengthened by data from multiple randomized controlled trials with a large sample size, thus increasing its validity.

Click to read the study in The Lancet

Relevant Reading: Labor Induction versus Expectant Management in Low-Risk Nulliparous Women

In-depth [meta-analysis]: 471 references were identified based on an initial search of randomized studies between Mar 19, 2019, and May 1, 2021. Altogether, 12 trials (5460 patients) met the study criteria and were included in the final analysis. The primary outcome of caesarean delivery was comparable among women who received balloon catheters versus vaginal prostaglandins (crude incidence 27.0%, adjusted odds ratio [aOR] 1.09, 95% confidence interval [CI] 0.95-1.24; I2=0%). This was also the case for individual indications for caesarean sections, such as caesarean delivery for failure to progress (aOR 1.20, 95% CI 0.91-1.58) and caesarean delivery for fetal distress (aOR 0.86, 95% CI 0.71-1.04). Both groups were comparable for adverse maternal outcomes (crude incidence 22.7%, aOR 1.02, 95% CI 0.89-1.18); however, fewer patients in the balloon catheter group reported adverse perinatal outcomes compared to those in the vaginal prostaglandin group (crude incidence 13.6%, aOR 0.80, 95% CI 0.70-0.92). Overall, findings from this study suggest that balloon catheters and vaginal prostaglandins may be comparable for C-section rates and maternal safety profiles.

Image: PD

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