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The Cook Cervical Ripening Balloon

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The Cook Cervical Ripening Balloon

At the recent Annual Clinical Meeting of the American College of Obstetricians and Gynecologists Cook Medical introduced its Cervical Ripening Balloon catheter, a device designed to accelerate cervical dilation prior to the induction of labor.

What is induction of labour?

 In most pregnancies, labour starts naturally between 37 and 42 weeks. Induction of labour is a process that is designed to start the labour process artificially.

Why do I need to be induced?

The most common reason for induction of labour is a prolonged pregnancy. After 41 completed weeks of pregnancy, there is an increased risk of a baby developing problems as the placenta becomes less efficient. If you have a medical condition such as diabetes or pre‑eclampsia, you may need to be induced before term. These conditions can slow the growth rate of your baby in the latter stages of pregnancy, making early delivery safer than continuing the pregnancy. For further information on the induction of labour, please read the induction of labour leaflet.

What is balloon induction?

A balloon is inserted into your cervix and inflated to dilate your cervix so your membranes can be broken.

Who is balloon induction suitable for?

Balloon induction is mainly used for women that have previously had a caesarean section and are now aiming for a vaginal birth.

How does balloon induction work?

The balloon rubs against and stretches the cervix causing it to produce a hormone called prostaglandin. The prostaglandin causes the cervix to become shorter and soften (ripening). This prepares the cervix for labour and allows your midwife or doctor to break your waters. Sometimes, the release of hormones as the cervix stretched is enough to trigger your waters to break naturally and for labour to begin.

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How is the balloon catheter fitted?

First a tracing of the baby’s heart will be done to check the heart rate and ensure all is well. Then you will be asked for your consent to perform a vaginal examination. This allows assessment of your cervix in preparation for the balloon to be inserted. The first of two balloons is inflated on the uterine side of the cervix; the second is then inflated in the vaginal side of the cervix. The two balloons adapt to the contour of the cervical canal minimizing discomfort for the patient. When the catheter is removed, cervical conditions should have improved to a favourable state to allow for induction of labour and active labour management…

How long does it take?

The balloon catheter is kept in place for 12–24 hours. It then either drops out of the cervix or is removed. At this point, it should be possible to break your waters. An instrument called an amnihook is passed through the cervix and used to create a small hole in the membranes surrounding your baby. This allows the fluid surrounding your baby to drain away. However if labour begins while the balloon is still in place, the balloon will either be taken out by your midwife or fall out.

Are there any risks or complications?

Inserting the balloon into the cervix is uncomfortable, but not normally painful. There is a very small risk of infection that would mean your baby would have to be delivered by a caesarean section.

How successful is the cervical balloon?

The balloon softens and widens the cervix enough for the waters to be broken in 96 out of 100 women.

What if the balloon doesn’t work?

If the cervix is not dilated enough for the doctor to insert the balloon or if the balloon doesn’t soften the cervix enough for the membranes to be broken, a caesarean section may be necessary. Your Doctor will discuss this with you.

Why do we use the cervical balloon and not the prostaglandin pessary or gel?

The prostaglandin pessary or gel is used in some women to induce labour. However, it is not suitable for those that have had a previous caesarean section because it can cause the womb to contract too strongly. This is a particular risk in women with a previous caesarean section because the scar is a weak point on the womb wall and there is a risk of it rupturing. Although the balloon also causes the production of prostaglandins, the contractions are not as strong because the gradual stretching of the cervix releases the prostaglandins slowly.

Article Written By – Kajal Parmar

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