RIPENING AND DILATATION OF THE UNFAVORABLE CERVIX FOR INDUCTION OF LABOR BY A DOUBLE-BALLOON DEVICE - EXPERIENCE WITH 250 CASES

Objective To determine the efficacy of the double balloon device (the Atad Ripener Device) in ripening and dilatation of the unfavourable ce rvix for induction of labour. Methods Two hundred and fifty women with unfavourable cervices (Bishop score less than or equal to 4) underwen t induction of labour with the Atad Ripener Device. Indications were p regnancy induced hypertension (n = 118), post-dates (n = 69), elective inductions (n = 23), other reasons including nonreassuring nonstress test, intrauterine growth retardation, previous caesarean section and diabetes mellitus (n = 40). The Atad Ripener Device was inserted into the cervix, the uterine balloon inflated in the internal os, and the c ervico-vaginal balloon in the external os of the cervix (100 mL, of no rmal saline to each balloon). Pressure produced by the inflated balloo ns caused gradual dilatation and effacement of the cervix. The Atad Ri pener Device was removed 12 h after insertion, the cervix assessed aga in, and labour managed according to obstetrical criteria. Results The Atad Ripener Device caused an increase in the Bishop score in all subg roups with a mean change of 4.6 (from 2.0 prior to induction to 6.6 up on removal of the Atad Ripener Device; p < 0.05). The mean time interv al from insertion of the Atad Ripener Device to delivery was 18.9 h, a nd from removal to delivery was 6.9 h. Caesarean section was performed in 39/250 patients (16%), and the others had a normal vaginal deliver y. Conclusions 1. The double balloon device induces significant ripeni ng and dilatation of the unfavourable cervix. 2. Induction of labour w as successfully achieved following removal of the Atad Ripener Device. 3. Our caesarean section rate was low compared with rates reported fo r women with an unfavourable cervix induced by other methods.