Comparison of 6-hour versus 12-hour cervical ripening balloon protocols in patients with prior cesarean delivery: A retrospective cohort study.

Objective: To compare the mode of delivery and other maternal and neonatal outcomes in patients with one prior cesarean delivery undergoing labor induction with a cervical ripening balloon (CRB) for 6 h versus 12 h.

Methods: This retrospective study compared two protocols for mechanical cervical ripening: CRB placement for 12 h (12-h group, implemented from 2014 to 2017) versus 6 h (6-h group, implemented from 2020 to 2021). The study included patients with one prior low-segment cesarean delivery. The primary outcome was mode of delivery, including the rate of vaginal birth after cesarean (VBAC). Secondary outcomes included cesarean delivery due to fetal distress or other indications, oxytocin use, umbilical cord pH, and neonatal intensive care unit (NICU) admission.

Results: A total of 171 patients were included, with 80 in the 6-h group and 91 in the 12-h group. Patients in the 6-h group were older and more likely to have had a prior vaginal birth, while induction due to oligohydramnios was more common in the 12-h group. Adjusted VBAC rates were similar between the groups (53.7% vs. 51.6%, P = 0.99). Secondary maternal and neonatal outcomes were also comparable between the groups.

Conclusion: Removal of the CRB after 6 h, as opposed to 12 h, does not negatively impact VBAC rates or other key maternal and neonatal outcomes in patients with a previous cesarean delivery. These findings suggest that a shorter CRB placement may be a viable option for this population.