Time matters: Cervical ripening balloon for 6 versus 12 h—Retrospective comparison between two protocols

Objective Recently, two randomized controlled trials compared removal of cervical ripening balloon (CRB) after 6 versus 12 h. Their results showed similar Bishop score changes in both groups and a shorter time to delivery in the 6‐h group. Neither of the studies was powered to show difference in mode of delivery. The aim of this study was to compare mode of delivery when the CRB was removed after 6 versus 12 h. Methods A historical control study comparing induction of labor with a CRB between two time periods, one in which the CRB was removed after 12 h (12‐h group), and the other in which it was removed after 6 h (6‐h group). We included term pregnancies with a singleton fetus in vertex presentation. We excluded patients with a previous cesarean delivery, failed ripening with prostaglandins prior to CRB insertion, and any contraindication for vaginal delivery. The primary outcome was mode of delivery. Secondary outcomes included delivery within 24 h and other maternal and neonatal outcomes. Results We included 1704 patients, 914 in the 12‐h group, and 717 in the 6‐h group. Removal after 6 h was associated with a lower rate of cesarean and instrumental deliveries (28.6% vs 22.5%, and 12% vs 6.2%, respectively) and a higher rate of vaginal delivery within 24 h. All differences were statistically significant. Conclusion Removing a cervical ripening balloon after 6 rather than 12 h is associated with reduced cesarean and instrumental delivery rates, and should be considered as a reasonable, and potentially superior alternative in labor induction protocols with intracervical ripening balloon. Synopsis Removal of cervical ripening balloon after 6 versus 12 h was associated with lower cesarean delivery rates and higher vaginal delivery rates within 24 h.