(1101) Optimizing Induction: Shortened Balloon Protocols for Better Outcomes

Objective: The optimal timing of mechanical balloon induction remains controversial. This meta-analysis compares the effectiveness of 6-hour versus 12-hour mechanical balloon induction protocols in reducing delivery time in term pregnancies.

Study Design: A comprehensive literature search was conducted using terms related to mechanical balloon induction. Randomized controlled trials (RCTs) comparing 6-hour and 12-hour induction protocols with various types of balloon catheters (single and double balloon) were included. The primary outcome was the interval time to delivery, defined as the time from the start of the induction process to delivery. The secondary outcomes were cesarean delivery rate (CD), operative vaginal delivery rate, time on oxytocin, and delta bishop score. The random-effects model was used to pool the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs).

Results: Four RCTs were included in the meta-analysis, encompassing a total of 972 participants. Overall, patients with a 6-hour balloon induction delivered 4.5 hours sooner compared to those with a 12-hour balloon ( mean difference -4.56, CI [-5.75,-3.37], P< 0.001). The risk of cesarean delivery was 1.5 times higher for patients with a 12-hour balloon compared to those with a 6-hour balloon (OR 0.67, 95% CI [0.47, 0.96], P= 0.028). Additionally, the risk of cesarean delivery due to non-reassuring fetal heart tones (NRFHTs) was 1.7 times higher in the 12-hour group (OR 0.59, 95% CI [0.36, 0.96], P =0.030). No significant differences were found in the rate of operative vaginal delivery, time on oxytocin, change in Bishop score, or starting and post-intervention Bishop scores between the two groups.

Conclusion: A 6-hour mechanical balloon induction protocol significantly reduces the interval to delivery and the risk of cesarean delivery, particularly due to NRFHTs, compared to a 12-hour protocol. These findings support the use of a shorter induction interval for improved maternal and fetal outcomes in term pregnancies.