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[Comparison of Methods for Cervical Ripening for Labor Induction for Fetal Indication: Mechanical vs.
Gal Bachar1, Nidaa Nassar2, Hiba Abu-Rass3
1Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Introduction:
The optimal method for cervical ripening during labor remains debated.
Aims:
To determine the effective cervical ripening method based on fetal indications.
Methods:
A retrospective cohort study was conducted at a single tertiary center (2010-2021). Enrolled nulliparous women had a Bishop score of ≤6 and vertex presentation undergoing labor induction for fetal well-being indications (including non-reassuring fetal heart rate). Participants were categorized based on the ripening method used: prostaglandin E2 (PGE2) or cervical ripening balloon (CRB).
Results:
The study included 716 nulliparous women: 462 (64.53%) induced by PGE2 and 254 (35.47%) induced by CRB. The duration from induction to delivery was similar for both PGE2 and CRB inductions (25 [15-41] vs. 26 [20-39] hours, p=0.34). There were no differences in delivery mode. Rates of chorioamnionitis and obstetric anal sphincter injury (OASIS) were lower with PGE2 (3.5% vs. 7.1%, p=0.021; 2.2% vs. 5.1%, p=0.034, respectively). No other significant differences were observed, including neonatal outcomes.
Conclusions:
Neither method demonstrated overall superiority in terms of efficacy or neonatal outcomes, although PGE2 exhibited a lower maternal risk profile. This point should be taken into consideration.
Discussion:
The study found similar efficacy between PGE2 and CRB for labor induction due to fetal indications in nulliparous women, with no difference in time to delivery or cesarean delivery (CDs). PGE2 demonstrated lower rates of chorioamnionitis and OASIS, suggesting better maternal safety. In cases of nulliparous women with an unripe cervix and fetal indications for induction, PGE2 and CRB are similarly effective. Nevertheless, PGE2 is associated with a lower risk of maternal complications.
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