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Labor

Poster Session 2

(393) Cervical dilation after cervical ripening balloon as a predictor of cesarean delivery during induction

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

Understanding predictors of cesarean delivery (CD) during induction of labor (IOL) is important to reduce CD rates and morbidity. We aimed to understand predictors of CD among patients who had an IOL with cervical ripening balloon.

Study Design:

Retrospective cohort study of 500 patients who had an IOL with cervical ripening. Labor events were extracted from the medical record and all cervical exams after balloon removal were recorded. STATA was used for statistical analysis with t-test for continuous variables and chi-square analysis and logistic regression for categorical variables, a p-value of < 0.05 was used to indicate statistical significance.

Results:

Of the 500 patients with a cervical balloon, 353 had a dual agent (89% Pitocin, 11% misoprostol). The overall risk of CD was 27%. Those who had a CD were more likely to be nulliparous with a higher BMI than those who did not have a CD (Table). The average cervical dilation of first exam was significantly different between groups with a mean of 3.5 cm vs 4.2 cm for those who did and did not have a CD, respectively (P< 0.01). Dual agent ripening vs cervical balloon alone was not significantly associated with CD. In a logistic regression model adjusting for age, race, BMI, and birthweight, a first cervical exam < or = 3 cm after removal of balloon was a significant predictor of CD with an adjusted OR of 1.77 (95%CI 1.15-2.70) A first exam < or = 3cm after balloon removal was also a predictor of CD prior to active labor (6cm) with an adjusted OR of 2.52 (95%CI 1.44-4.41). Cervical dilation at first, second and third exam after balloon removal were also independent predictors of CD in adjusted logistic regression models.

Conclusion:

For those undergoing induction of labor, those with a cervical dilation of < or = 3cm after cervical ripening balloon have a higher risk of cesarean delivery (aOR 1.77) and specifically a higher risk of CD for a failed induction (aOR 2.52). Cervical exam after balloon ripening could potentially be used as an intrapartum risk stratification tool for cesarean delivery risk.