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Grand Rounds

Meta-analysis: Safety of Balloon Catheter for Induction in the Setting of Ruptured Membranes

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BACKGROUND AND PURPOSE:

  • Mackeen et al. (AJOG, 2021) compared outcomes with an intracervical balloon catheter vs a pharmacologic agent for labor induction following PROM

METHODS:

  • Systematic review and meta-analysis
  • Inclusion criteria
    • RCTs
    • Studies that compared induction after PROM at or near term with
      • Balloon catheter with or without pharmacologic agents
      • Pharmacologic agents alone
  • Study design
    • Risk of bias was assessed using the Cochrane risk-of-bias tool
    • Preplanned subgroup analyses included
      • Comparison of balloon catheter with or without pharmacologic agent vs oxytocin, vs misoprostol, and vs dinoprostone
  • Primary outcome
    • Intraamniotic infection (IAI)
  • Secondary outcomes
    • Time to vaginal delivery
    • Cesarean delivery and indication for cesarean delivery
    • PPH
    • Endometritis
    • Neonatal outcomes: Suspected neonatal infection or culture-proven neonatal sepsis | NICU admission | 5-minute Apgar score <7

RESULTS:

  • 4 studies | 605 women
  • There was a trend towards an increased risk of intraamniotic infection (IAI) in those treated with balloon catheter vs pharmacologic agents, although the CI crossed 1
    • Risk ratio 1.84 (95% CI, 0.91 to 3.73)
  • There was a 3.2-fold increase in the risk of IAI for induction with balloon catheter compared to induction with oxytocin (without balloon catheter)         
    • ICBC: 9.7%
    • Oxytocin: 2.9%
    • Relative risk 3.20 (95% CI, 1.17 to 8.70)
  • There were no significant differences in secondary outcomes
  • There were no differences in any of the preplanned subgroup analyses, though many could not be conducted due to lack of evidence

CONCLUSION:

  • The use of intracervical balloon catheter for induction of labor with PROM more than doubled the risk for intraamniotic infection, compared to induction with pharmacological methods, specifically oxytocin
  • The authors state

The increased risk of IAI was most significantly clear when the intracervical balloon catheter group was compared with the oxytocin group, as rates of IAI were 3.2-fold higher in those treated with the intracervical balloon catheter

These findings support the use of pharmacologic agents, specifically oxytocin, for IOL in PROM

Learn More – Primary Sources:

Intracervical balloon catheter for labor induction after rupture of membranes: a systematic review and meta-analysis

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Related ObG Topics:

PROM 37 Weeks and Beyond: Induction or Watchful Waiting?
Foley Bulb Catheter for Induction Following PROM in Nulliparas
Does Adding a Foley to Oxytocin Following PROM Improve Time to Delivery?

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