Double balloon device for labor induction in women with and without previous cesarean delivery

Abstract Purpose Induction of labor (IOL) after cesarean delivery is reasonable option and should be discussed. While IOL has been shown to be superior to expectant management in low-risk nulliparous women, the literature in women after cesarean delivery (CD) is sparse. The aim of our study was to compare IOL between in nulliparous women to women who had IOL after cesarean (TOLAC) Methods This was a retrospective cohort study, from two medical centers, that compared between TOLAC and nulliparous women who had IOL with a double balloon device. Inclusion criteria were: singleton pregnancy > 37 + 0 weeks and no contraindication for vaginal delivery. We excluded women who withdrew their consent for TOLAC. Primary outcome was the mode of delivery. Results: We compared 161 TOLAC to 1577 nulliparous women. Vaginal delivery rate was 70% in both groups, and CD rate remained similar even after adjusting for confounders (29.8% vs. 28.9%, OR 1.1, 95% CI = 0.76–1.58, p = 0.59). CD due to non-reassuring fetal heart rate (NRFHR) was more common in the TOLAC group (75% vs. 56%, p = 0.014) and CD due to non-progressive labor (NPL) was more likely in the Nulliparous group (45.4% vs. 25%, p = 0.014). Other secondary maternal and neonatal outcomes remained similar between groups. Conclusion: Induction of labor, with double balloon device in women with a previous cesarean delivery, results in a similar vaginal delivery rate when compared to nulliparous women, with no additional adverse maternal or neonatal outcome. Labor progression might be different in these women attempting TOLAC, and if managed accordingly, VBAC can be achieved in a higher rate when given a genuine trial of labor, regardless of a previous vaginal delivery.