Audit of clinical outcomes following induction of labour using balloon catheter and prostaglandin gel

Abstract

Introduction: To report the outcomes of women following induction at labour at term and to determine whether the method of induction (balloon catheter versus prostaglandin gel) influences maternal, neonatal and process outcomes. Methods: Case-control design using routinely collected deidentified data of 1503 women who presented to the Mater Mother's Hospital, Brisbane, Australia, (between January 2014 and January 2016) requiring induction of labour (IOL) with a modified bishop's score <7. Those who underwent cervical ripening with a double balloon catheter were matched 1:1 for parity, indication and modified Bishop score to those using prostaglandin E2 gel. The primary outcome measure was mode of birth (unassisted vaginal birth, operative vaginal birth or caesarean section). The secondary outcomes included maternal (eg epidural, blood loss at delivery), neonatal (eg birthweight, cord arterial pH <7.1, nursery admission) and process (eg time form IOL-to-birth, vaginal delivery within 24 hours) outcomes. Results: 1503 public-funded women were included, after exclusions, 427 were induced with a balloon catheter and 427 with Prostaglandin gel. Compared to women receiving prostaglandin gel, those induced using a balloon catheter were more likely to have an unassisted vaginal birth (50.4% versus 42.9%; p = 0.028), a lower mean estimated blood loss (420 ml versus 481 ml; p = 0.028), a reduction in fetal acidemia (2.4% versus 8.8%; p = 0.003) and a greater likelihood experiencing vaginal delivery within 24 hours (33.7% versus 25.8%; p-0.011). Discussion: Similar to findings in randomised controlled trials and meta-analyses of IOL methods, we observed less blood loss, fetal acidaemia, a greater likelihood of vaginal delivery within 24 hours, and an increased likelihood of unassisted vaginal birth with the balloon catheter.L613101810 <br />