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Geburtshilfe Frauenheilkd 2015; 75(11): 1130-1139
DOI: 10.1055/s-0035-1558094
Review
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

The Renaissance of Transcervical Balloon Catheters for Cervical Ripening and Labour Induction

Renaissance des transzervikalen Ballonkatheters zur Zervixreifung und Geburtseinleitung
W. Rath
1   Faculty of Medicine, Gynaecology and Obstetrics, University Hospital RWTH Aachen, Aachen
,
S. Kehl
2   Department of Obstetrics and Gynaecology, University Hospital Erlangen, Erlangen
› Author Affiliations
Further Information

Publication History

received 01 June 2015
revised 07 July 2015

accepted 15 July 2015

Publication Date:
14 December 2015 (online)

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Abstract

Due to rising rates of labour induction in industrialised countries, safe and effective methods of induction have once again become a focus of interest and research. Prostaglandins are effective for cervical ripening and induction of uterine contractions. They do, however, cause overstimulation of the uterus in up to 20 % of cases, sometimes causing changes in fetal heart rate. Transcervical balloon catheters provide an alternative to prostaglandins for labour induction and have been used for this purpose for almost 50 years. This induction method has experienced a recent renaissance in clinical practice that is reflected in an annually rising number of publications on its use. Balloon catheters allow gentle ripening of the cervix without causing uterine overstimulation. The two catheters available are the Foley catheter (off-label use) and the double balloon catheter, which is licensed for use in induction of labour. Both are as effective as prostaglandins, and do not increase the risk of infection to mother or child. Catheter induction also requires less monitoring compared to prostaglandins resulting in improved patient satisfaction. Balloon catheters provide a useful and promising option to achieve vaginal delivery despite failed prostaglandin induction. Intravenous oxytocin is nevertheless required in up to 85 % of cases for adequate induction/augmentation of contractions. Balloon catheters, vaginal PGE2 and misoprostol are equally effective in the context of an unripe/unfavourable cervix, the rate of uterine hyperstimulation being significantly lower, and the need for oxytocin significantly higher for catheters. Balloon catheters are increasingly being used in combination or sequentially with oral/vaginal misoprostol, although there is currently inadequate published data on the subject. International guidelines recommend the use of balloon catheters for labour induction with an unripe cervix (also following previous caesarean section) as an alternative to prostaglandins, particularly when these are not available or are contraindicated.

Zusammenfassung

Angesichts steigender Raten in den Industrieländern ist die Frage nach effektiven und sicheren Methoden der Geburtseinleitung wieder in den Fokus des Interesses gelangt. Prostaglandine sind effektiv zur Zervixreifung und Weheninduktion, weisen aber auch in bis zu 20 % der Fälle uterine Überstimulierungen mit und ohne fetale Herzfrequenzveränderungen auf. Eine Alternative ist der seit fast 50 Jahren zur Geburtseinleitung angewandte transzervikale Ballonkatheter, der – wie jährlich steigende Publikationszahlen zeigen – eine Renaissance erfahren hat. Ballonkatheter ermöglichen eine schonende Zervixreifung ohne uterine Überstimulierungen. Zur Verfügung stehen der Foley-Katheter (off-label use) und der für die Geburtseinleitung zugelassene Doppelballonkatheter, die so effektiv sind wie Prostaglandine, das Infektionsrisiko für Mutter und Kind nicht erhöhen und bei im Vergleich zu Prostaglandinen geringerem Überwachungsaufwand eine gute Akzeptanz bei den Schwangeren aufweisen. Nach frustraner Geburtseinleitung mit Prostaglandinen sind Ballonkatheter eine vielversprechende Option, noch eine vaginale Geburt zu erreichen. Zur Weheninduktion/-verstärkung ist allerdings in bis zu 85 % der Fälle Oxytocin intravenös erforderlich. Hinsichtlich der Effizienz weisen Ballonkatheter und vaginales PGE2 sowie Misoprostol bei unreifer Zervix keine signifikanten Unterschiede auf, die Rate uteriner Überstimulierungen ist signifikant niedriger, der Oxytocinbedarf signifikant höher. Zunehmend häufiger wird der Ballonkatheter in Kombination oder sequenziell mit oralem/vaginalem Misoprostol eingesetzt, allerdings ist die Datenlage bisher unzureichend. Internationale Leitlinien empfehlen die Anwendung des Ballonkatheters zur Geburtseinleitung bei unreifer Zervix (auch nach vorangegangener Sectio caesarea) als Alternative zu Prostaglandinen, insbesondere dann, wenn diese nicht zur Verfügung stehen oder kontraindiziert sind.

Key words

labour induction - balloon catheter - prostaglandins - effectiveness - safety

Schlüsselwörter

Geburtseinleitung - Ballonkatheter - Prostaglandine - Effektivität - Sicherheit

Supporting Information

 

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