Induction of labour with cook® cervical dilator balloon catheter for women with one previous caesarean section: experience at York teaching hospital

Vaginal birth after Caesarean Section (VBAC) carries risks of uterine rupture, with increased perinatal mortality risk. When labour is induced there may be higher uterine rupture and repeat caesarean section (CS) rates in women with previous CS, compared to when labour starts spontaneously.1 The method of induction of labour (IOL) in women with previous CS remains controversial, as there is a higher risk of uterine rupture when prostaglandins (PGs) are used compared with the use of non-prostaglandin methods.2 For women with previous CS, NICE guidance recommends PGs for routine use in IOL,3 however, obstetricians concerned about the increased uterine rupture risk may prefer to offer elective CS instead, therefore increasing CS rates. Comparisons between the use of cervical dilator balloon catheters versus PGs in nulliparous women have shown similar efficacy in establishing labour, without the risks of uterine hyperstimulation or rupture.4 5 IOL with Cook cervical dilator balloon was introduced into practice at York Teaching Hospital in 2009, as an alternative to repeat CS for women with previous CS. Of 64 women booked for balloon catheter IOL from January 2009 to July 2011, 11 proceeded to placement of a Cook cervical dilator balloon. Of these women nine were suitable for artificial rupture of membranes (ARM) following the procedure and six of the 11 women proceeded to a vaginal delivery. 41 of the 64 women progressed into spontaneous labour whist awaiting IOL giving further weight to suggestions that scheduling elective repeat caesarean sections at 41-42 weeks gestation will improve VBAC rates.