Induction of Labor in Gestational Diabetes

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The goal of management of a diabetic mother should focus on the prevention of stillbirth, prevention of asphyxia and minimizing maternal and newborn morbidity associated with delivery. In order to achieve those goals it is important to select the proper timing and the best route of delivery. Delaying delivery as near as possible to estimated due date helps to maximize cervical ripeness and improves the chances of spontaneous labor. On the other hand, yet the risks of fetal macrosomia, birth injury and fetal death increase as the due date approaches. Those two mentioned approaches are a subject of controversies in the management of labor in a diabetic woman. The optimal timing of delivery is agreed by most of experts in the field and ranges between 38.5 and 40 weeks gestation. At that stage lung maturity is obtained and it is calculated that by inducing labor then the chances of a macrosomic infant are reduced from 23% to 10%.

In this presentation we would like to report on our studies and results of labor induction using the double balloon device. This method of labor induction might be the method of choice for labor induction in women with an unfavorable cervix as we often meet before term.

The following four studies are presented in order to demonstrate our experience using the double balloon device (ARD):

1. Induction of labor by the double balloon device: experience of 250 cases

2. A randomized comparison of labor induction by PGE2 vaginal tablets, oxytocin and the double balloon device (ARD).

3. Induction of labor by the combination of the double balloon device and half doses of PGE2 vaginal gel.

4. The outcome of pregnancies following labor induction by the double balloon device.

Ripening and Dilation of the Unfavorable Cervix for Induction of Labor by the Double Balloon Device: Experience With 250 Cases

J.Atad, M.Hallak, R.Auslender, H.Abramovici

Dept. OB&GYN. Carmel Medical Center, Haifa, Israel 

Objective: To determine the efficacy of the double balloon device for labor induction

Methods: 250 women with unfavorable cervices underwent labor induction by the double balloon device (ARD).

Results: The ARD increased the Bishop score from a mean of 2 to 6.6. The mean time from insertion of the device to delivery was 18.9 hours and from removal to delivery 6.9 hours. The cesarean section rate was only 16%.

A Randomized Comparison of Pge2 Vaginal Tablets, Oxytocin and the Double Balloon Device for Labor Induction

Jack Atad, Tamy Porat -Pecker*

*M.D Thesis

Objective: To compare the efficacy of the three methods of labor induction

Methods: Labor induction was performed in women with unfavorable cervices. The women in the study were randomized into one of the three methods.

Results: The double balloon device (ARD) and the PGE2 vaginal tablets were more successful in inducing labor than the oxytocin. Cervical dilation above 3 cm within 12 hours from the beginning of the induction was more frequent in the ARD group compared to both the PGE2 and the oxytocin groups (86% compared to 50% and 23% respectively). The mean induction to delivery interval was the shortest for the ARD group.

This study shows that the ARD has a significant better success rate for cervical dilation and labor induction compared to PGE2 vaginal tablets and oxytocin.

Combination of the Double Balloon Device (ARD) and Half Doses of Pge2 Vaginal Gel for Labor Induction 

Jack Atad ,Gil Peer*

*M.D Thesis

Objective: To compare the efficacy and the complication rates of the combination of the ARD with reduced doses of PGE2 vaginal gel for labor induction.

Methods: Women with unfavorable cervices were induced with the double balloon device and were randomized to addition of half dose of PGE2 vaginal gel or placebo gel.

Results: Significant differences were noted in the combined group of the ARD and the PGE2 vaginal gel:

a) More frequently cervical dilatation above 3 cm was found 12 hours following the beginning of the induction process.

b) Fewer women required an addition of oxytocin infusion.

c) More frequently full cervical dilatation was achieved within 12 hours from the beginning of the labor induction process.

d) The induction to delivery interval was shortened in the combination group by almost 4 hours.

e) A low rate of cesarean section was recorded - 13.3%

f) All the advantages achieved without increasing complication rates.

The Outcome of Pregnancies Following Labor Induction by the Double Balloon Device (ARD).

Jack Atad, Liora Saggy*

*M.D Thesis

Objective: To evaluate long term impacts of labor induction by the double balloon device such as the incidence of pre-term labor and spontaneous abortions in pregnancies following the induction. 

Methods: A retrospective study in whish 150 women participated. All underwent previously induction of labor by the double device

Information concerning pregnancies before and following the labor induction was obtained through a questioner.

Results: From the 150 women in the study group information was obtained from 173 pregnancies that occurred before the labor induction and from 179 pregnancies that occurred following labor induction. The outcome of those two groups of pregnancies was compared. No statistical difference in the incidence of spontaneous early abortions (11.1% and 9.4%), late abortions (2.3% and 1.1%) or pre-term labor (2.9% and 3.9%) was noted before and following the labor induction by the ARD.