Tag Archives: induction

NIHR Signal: Waiting at home after inducing labour mechanically may be an option for low-risk women

Maternal or fetal complications, following the insertion of a balloon catheter to induce labour, are rare. Pain or discomfort was most common affecting around 1 in 400 women. Balloon displacement, bleeding or abnormal fetal heart rate affected less than 1 in 1,000.

The catheter is a device inserted through the cervix, where inflated balloons on the end of a tube put pressure on the cervix helping it to “ripen” and start contractions. Prostaglandin drugs are the current recommended induction method, but uterine (womb) overstimulation, where contractions become too frequent or long, is a recognised side effect.

Individual trials have indicated that catheter induction could be a safer alternative. This review is the first to gather the available evidence from 26 studies including 8,292 women that have reported the adverse event rate for catheters.

It supports balloon catheters as an induction method for low-risk pregnancies that could allow women to stay at home, benefiting the mother and saving NHS resources.

“This review provides encouraging evidence for the safety of balloon catheter cervical ripening in an outpatient setting. Adopting this technique for low-risk pregnancies could significantly improve women’s birth experience as well as economically benefiting the NHS. Is it time we reconsidered our induction methods?”

Sally Collins, Consultant Obstetrician & Subspecialist in Maternal & Fetal Medicine, Oxford University Hospitals NHS Foundation Trust; Associate Professor, Nuffield Department of Women’s & Reproductive Health, University of Oxford; Lecturer in Medical Sciences, St Anne’s College, University of Oxford

Diederen M, Gommers J, Wilkinson C, et al. Safety of the balloon catheter for cervical ripening in outpatient care: complications during the period from insertion to expulsion of a balloon catheter in the process of labour induction: a systematic review. BJOG. 2017. [Epub ahead of print].


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NIHR Signal: Induction of labour may be considered in pregnant women with a large baby

Image Source: NIHR

Induction of labour does not increase the risk of caesarean delivery in pregnant women with a larger than average baby.

This is based on a review of four trials of 1190 women with a suspected large baby who were allocated either to have labour induced from 38 weeks or to watchful waiting.

Induction did not increase the risk of most negative outcomes for the baby, such as bleeding in the brain, or mother, such as major tearing. However, these outcomes are rare, so a larger number of women would need to be studied to be confident in these findings. When mothers were not induced babies were larger and born about a week later than if they were induced. They did suffer from more fractures, which can be a complication of delivering a larger baby.

Current guidance recommends only offering induction at 41 or 42 weeks in otherwise healthy women who have a larger than average baby.

This analysis suggests that earlier induction is likely to be safe and may be an option for women to consider.

Read the whole review here

NIHR Signal: Induction of labour within 24 hours, if waters break at 37 weeks of pregnancy, can reduce womb infection

Image Source: Wikimedia

Inducing labour may halve the risk of infection in the womb when waters break from 37 weeks. The procedure was started within 24 hours and was compared to waiting for labour to start on its own.

Waters breaking at full term without the onset of labour is called pre-labour rupture of membranes. This can increase risks of maternal and neonatal infection and the need for caesarean section. As most women deliver spontaneously within a day, NICE recommend that women are offered an informed choice of either induction 24 hours after premature rupture of membranes or to watch and wait.

This updated Cochrane review included new evidence and suggests that induction before 24 hours may reduce infections without increasing caesarean sections, but there remains some uncertainty. This is due to low study quality, lack of longer term outcomes, and too few participants in trials to compare the numbers of any rare serious events.

These findings may help inform shared decisions about induction by providing more information to help women understand the risks.

Read the full Signal here