Mechanical ripening of the unfavorable cervix for induction of labor

M. Hallak

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Induction of labor remains one of the therapeutic challenges in obstetrics. Several pharmaceutical agents have been reported for cervical ripening. These medications may cause maternal side-effects as well as uterine hypertonicity and fetal distress. In this paper we describe our experience with a double balloon catheter. This device causes mechanical ripening and dilatation of the unfavorable cervix. The objective of the first study was to determine the efficacy of the double balloon catheter in ripening and dilatation of the unfavorable cervix for induction of labor. We report our experience with 250 women with unfavorable cervices (Bishop score ≤ 4) who underwent induction of labor with this device. The double balloon catheter caused an improvement in the Bishop score with a mean change of 4.6. The mean time interval from insertion to delivery was 18.9 h, and from removal to delivery 6.9 h. Cesarean section was performed in 16%, and the rest of the patients had normal vaginal delivery. We concluded that the double balloon device induces significant ripening and dilatation of the unfavorable cervix with a low complications rate. Our next stage was to compare the efficacy of three methods for ripening and dilatation of the unfavorable cervix for induction of labor intravaginal prostaglandin E2 (PGE2), intravenous oxytocin, and the double balloon device. In this prospective randomized study 30 subjects were included in the PGE2 group, 30 in the oxytocin group, and 35 in the double balloon catheter group. The postpartum course was comparable in all. The change in Bishop score in the PGE2 and double balloon catheter groups was significantly better than in the oxytocin group (median and range of 5 (0-9) and 5 (0-7), respectively, vs. 2.5 (0-9), p < 0.01). Cervical dilatation of > 3 cm was more frequent and the success rate was higher in the double balloon catheter group compared with both the PGE2 and oxytocin groups. In conclusion, the mechanical ripening device had a significantly better success rate for cervical dilatation and a lower failure rate than those for PGE2 and oxytocin. The PGE2 and mechanical ripening device groups had better results than the oxytocin group in regard to Bishop score change and induction to delivery interval. The mechanical ripening device may be a superior alternative method for cervical ripening and labor induction in patients with unfavorable cervices.

Original languageEnglish
Pages (from-to)99-105
Number of pages7
JournalContemporary Reviews in Obstetrics and Gynaecology
Issue number2
StatePublished - 26 Sep 1997
Externally publishedYes

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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