Comparison of the efficacy of 40 ML and 80 MML cervical balloon for induction of labor

Objective: We aimed to investigate the effect of volume difference on cervical maturation using a 40 ml and 80 ml cervical ripening double balloon catheter in patients with low cervical Bishop score, with an indication of termination of pregnancy due to obstetric balance and for different indications. Material and Method: 40 pregnant women with single fetus, vertex presentation and bishop score of ≤ 5 were included in the study. Forty pregnant women were randomized to receive a cervical maturation and dilatation procedure in 20 pregnant women by inflating the cervical ripening catheter with double balloon in 40 ml and the other 20 pregnants with 80 ml. Immediately after discarding cervical maturing balloon catheter, induction with oxytocin was started. In both groups, the effects of volume difference on the duration of delivery were evaluated. For statistical analysis, appropriate analysis methods were used in IBM SPSS statistics 18.0 program. Results: The rate of the patients who were included in the study but performed caesarean section for different reasons was 28%. After insertion of the balloon, the time passed untill the birth was 15.98 ± 5.26 hours in 40 ml group and 19.18 ± 9.81 hours in 80 ml group (P = 0.301). The mean duration of balloon survival in 40 ml was 7,73 ± 3,14 hours and it was 11,20 ± 6,09 hours in 80 ml group (p = 0,063). The period for amniotic fluid flow after the insertion of baloon were 11,14 ± 3,92 hours in 40 ml and 15,32 ± 8,01 hours in 80 ml.before the expulsion and 3.94 ± 3.12 hours in 40 ml and 4.21 ± 3.26 hours in 80 ml. after the expulsion. The induction period which started immediately after the balloon expulsion was 7,87 ± 5,21 hours in 40 ml and 7,65 ± 5,36 hours in 80 ml group and there was no statistically significant difference between them (p = 0,916). Bishop score increase was 3,75 ± 1,52 in 40 ml group; It was 5,10 ± 1,29 in 80 ml group and it was found to be statistically significant (p = 0,009). In the 80 ml group; as the cervical length increased, the duration of balloon prolonged and it was statistically significant but not in the 40 ml group. However, cervical length did not affect the duration of induction between groups. Discussion: The double balloon catheter which is one of the cervical maturation methods, seems to be a safe and effective method. The results are assuring if applied in patients with appropriate conditions. Although the duration of labor was statistically insignificant, it was found to be shorter in 40 ml group. The increase in Bishop scores was significant in both groups, but higher in favor of 80 ml group. In addition to the mechanical effect of the cervical ripening balloon catheter, the inflammation caused by the bi-directional pressure and foreign body reaction to the cervix constitutes the mechanisms of action we know for the time. Although the 40 ml balloon was statistically insignificant, the expulsion time was shorter, the amnion fluid arrival time was shorter, the time between the balloon and the birth time was shorter, and the difference between Bishop scores was significant in both groups as it made us think that it was more effective at birth. Bishop scores increases more in 80 ml group, but the rate of birth is more positive in 40 ml, perhaps starting with lower volume and increasing the balloon volume at certain intervals may be more effective monitoring. Keywords: Cervical ripening double balloon catheter, Cervical maturation, Induction of labor.