Induction of labour with sequential double-balloon catheter and oral misoprostol versus oral misoprostol alone in obese women

Abstract

Induction of labour with sequential double-balloon catheter and oral misoprostol versus oral misoprostol alone in obese women Sven Kehla,*, Tilman Borna, Christel Weissb, Florian Faschingbauera, Jutta Pretschera, Matthias W. Beckmanna, Marc Sütterlinc, Ulf Dammera a Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany b Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Germany c Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Germany A R T I C L E I N F O Article history: Received 6 March 2019 Accepted 29 April 2019 Available online 1 May 2019 Keywords: Induction of labour Body mass index Double-balloon catheter Misoprostol Sequential use A B S T R A C T Objective: To evaluate the efficacy of induction of labour in obese women using sequential double-balloon catheter and oral misoprostol in comparison with oral misoprostol alone. Study design: In this cohort study, 400 pregnant women with BMI higher than 35 kg/m2 undergoing labour induction at term were included. Induction of labour with a double-balloon catheter and, if necessary, sequential oral misoprostol (n = 216) was compared to oral misoprostol alone (n = 184). The primary outcome measure was the caesarean section rate. Secondary outcome parameters were, among others, the induction-to-delivery-interval, the rate of vaginal delivery within 24 and 48 h as well as fetal outcome parameters. Results: The caesarean section rate was significantly lower in the group with sequential use of doubleballoon catheter and oral misoprostol (27.6% versus 37.5%, p = 0.0345). After stratification for parity this reduction was seen especially in nulliparous (38.6% versus 56.9%, p = 0.0039). The rate of abnormal CTG was significantly lower as well (19.9% versus 30.4%, p = 0.0150), particularly in nulliparous (25.9% versus 40.4%, p = 0.0138). Uni- and multivariable analyzes showed that the caesarean section rate was significantly influenced by the method of induction of labour (p = 0.0026), parity (p < 0.0001) and Bishop score (p = 0.0425). Conclusion: In obese women, induction of labour with sequential use of double-balloon catheter and oral misoprostol is associated with significantly more normal vaginal deliveries and less caesarean sections.