Extended balloon labor induction reported effective


In a recent study, efficacy and acceptability was found in patients with a favorable cervix who received an extended balloon labor induction.

Extended balloon labor induction reported effective | Image Credit: © InsideCreativeHouse - © InsideCreativeHouse - stock.adobe.com.

Extended balloon labor induction reported effective | Image Credit: © InsideCreativeHouse - © InsideCreativeHouse - stock.adobe.com.

According to a recent study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology: X, side-by-side balloons are effective in achieving vaginal birth in patients with favorable cervix.

Worldwide increases in labor induction rates have been observed, with rates in United Kingdom hospitals from 2015 to 2017 ranging from 17.5% to 40.7%. These rates indicate a need to research safe and effective methods to induce labor in patients. This included mechanical methods such as passing an extra-amniotic balloon through the uterine cervix.

While use of a foley catheter to induce labor in patients with an unfavorable cervix has decreased over time, overall patient satisfaction with balloon catheters has been reported as high. 

Safety and efficacy data have led to foley catheter induction of labor being recommended in the United Kingdom. However, while this method is effective for an unfavorable cervix, a favorable cervix is too dilated to hold a single balloon. 

An “extended balloon labor induction” method was developed to use 2 or more Foley balloons side-by-side in a cervix which cannot hold a single balloon. Investigators conducted a prospective, single arm clinical trial to evaluate the safety and efficacy of this method.

The study occurred from February 2022 to July 2022 at the Princess Marina Referral Hospital (PMH). Participants included nulliparous and multiparous women aged 18 years or older admitted to PMH for induction of labor.

Inclusion criteria included no serious morbidity, having a cervix too dilated for a single balloon or a single balloon falling out before labor, a modified Bishop cervical score of 7 or above, a gestation of 37 weeks or more, a fetal weight below 4 kg, and being singleton and cephalic. Patients with a prior cesarean birth or urgent labor induction indication were excluded.

Patients receiving extended balloon labor induction had 3 Foley catheters FG18 with a 30 ml balloon together at mid-shaft. Afterward, balloons were passed through the cervix. Monitoring included maternal and fetal checks every 4 to 6 hours. Maternal checks included measurements of blood pressure, heart rate, contraction presence, and temperature.

Fetal checks included measuring heart rate with a cardiotocography or doptone. Adverse outcomes were reported, including postpartum hemorrhage, blood transfusion, maternal infection, need for resuscitation, and admission to neonatal intensive care unit (NICU).

There were 20 participants included in the final analysis, with pre-induction modified Bishop cervical scores of 7 to 8. No instances of uterine hyperstimulation during labor were reported, and no 5-minute Apgar scores were below 7. Brief neonatal resuscitation was reported in 1 infant, but none had NICU admission.

Post-partum hemorrhage without the need for blood transfusion was reported in 1 participant. Another participant had intrapartum respiratory infection and a positive COVID-19 infection unrelated to the study intervention. There were no puerperal infections reported. Of mothers, 9 reported accepted discomfort at insertion, 10 painful but acceptable, and 1 unbearable.

The vaginal birth rate from extended balloon labor induction was 85%, proving efficacy. These results supported the use of this method in patients with a favorable cervix. Investigators recommended further research to determine the benefits of extended balloon labor induction.


Matshitsa L, Mercy-Nkuba N, Hofmeyr GJ. Extended balloon labour induction: A single arm proof of concept trial. Eur J Obstet Gynecol Reprod Biol X. 2023;19:100226. doi:10.1016/j.eurox.2023.100226

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