3 The procedure

Guidance

3.1 Insertion of a double balloon catheter for induction of labour at term in pregnant women aims to facilitate induction through causing dilation of the cervix when the cervix is unfavourable for induction. The double balloon is claimed to stimulate local prostaglandin release, which leads to cervical ripening, through the 2 balloons squeezing the cervix.

3.2 The procedure is usually done with the woman in a lithotomy or supine position. A sterile speculum is inserted into the vagina to gain access to the cervix. The cervix is then prepared by cleaning with an appropriate antiseptic solution before inserting the device. A double balloon catheter (with a uterine balloon and a vaginal balloon) is inserted through the cervical canal and into the uterus, so that the tip of the catheter lies in the extra‑amniotic space. The uterine balloon is then inflated with a small amount of saline and the catheter is gently pulled back until the uterine balloon lies against the internal cervical os. The vaginal balloon is also inflated with saline so that it lies against the external cervical os. Both the balloons are inflated alternately, and incrementally, with small amounts of saline. When the balloons are fully inflated and in place on both sides of the cervix, the speculum is removed. The external end of the device is loosely taped to the woman's inner thigh.

3.3 Following the insertion of the double balloon, a fetal non‑stress test is done and sometimes extra‑amniotic saline is infused at the same time. The mother and fetus are monitored and the device is left in place for up to about 12 hours. If labour begins, or spontaneous device expulsion or rupture of membranes have occurred, or if fetal distress is suspected, the balloons are deflated and the device is removed to facilitate labour management. If labour does not begin spontaneously, the membranes are ruptured artificially and oxytocin infusion is started.