Cervical Ripening Balloon Midwifery Educators
Objectives • To understand the action of the cervical ripening balloon • Discuss the technique of insertion and removal of the cervical ripening balloon
What is it? • The cervical ripening balloon catheter is a device designed to mechanically accelerate cervical dilation prior to induction of labour with amniotomy and syntocinon infusion.
How does it work? • Ripening and dilation is accomplished by the balloon‘s gentle and constant pressure at the uterine end of the cervix. • When the catheter is removed, cervical conditions should have improved to a favourable state to allow for induction of labour and active labour management...
Why choose this method? • Safely ripens and dilates the cervix without pharmaceuticals • Eliminates the potential side effects of repeat medications • Easily placed and quickly removed
Contraindications • All contraindications to induction of labour and vaginal delivery, including the following: - Active herpes - Fetal malpresentation - Abnormal CTG - A history of prior difficult or traumatic delivery - Regular contractions - Unexplained bleeding per vagina - Placenta praevia - Vasa praevia • Regular contractions • Maternal fever • A history of a prior caesarean section or major uterine surgery is a relative contraindication because of the increased risk of uterine rupture
Prior to procedure • Introduce self • Confirm appropriate indication for induction of labour • Confirm gestation and expected date of birth • Documentation of previous vaginal examinations and Bishops score • Documentation of relevant history • Confirm woman’s ID (3 identifiers) • Explain procedure to woman • Obtain verbal informed consent • Perform a full set of observations • Perform abdominal palpation to determine fetal lie and presentation • Confirmation of presentation using ultrasound by accredited clinician • Ensures pre procedure baseline CTG is normal
Equipment Equipment that you will need: • Sterile lubricant • 16g Foley catheter with a 30ml size balloon • Aqueous Chlorhexidine or warm soapy water • Large bivalve speculum • 40mls sterile water for injection • Labour ward bed with stirrups • 20mls Luer-lock syringe • Rampley’s Sponge forceps • Spigot or umbilical cord clamp • Adhesive tape
Procedure • Perform routine hand hygiene • Put on sterile gloves, and perform vaginal examination with consent to determine Bishops score. • Remove gloves and perform routine hand hygiene • Place the woman into lithotomy with a wedge • Perform routine hand hygiene and then put on sterile gloves • Clean the woman’s vulvovaginal region with aqueous chlorhexidine • Using an appropriately sized bivalve speculum, gently insert speculum and visualize the cervix • Clean the cervix with aqueous chlorhexidine
Procedure • Advance the 16g foley catheter through the internal OS of the cervix using sponge forceps to assist.
Procedure cont. • Inflate the uterine balloon with 30-40 mL of sterile water. Spiggot or clamp (using umbilical cord clamp) the catheter. Gently withdraw the catheter until it rests at the level of the internal OS.
Procedure cont. • Remove the speculum • Remove gloves • Perform routine hand hygiene • Apply traction to the catheter by taping it to the inner aspect of the woman’s thigh. • Explain to the woman that the balloon catheter may be left in-situ between 12 and 18 hours before removal and to alert staff if it falls out prior. • Commence CTG post procedure
Removal of the balloon • Deflate the balloon at 12-18 hours • Gently remove catheter from vagina
References Atad J, Hallak M, Ben-David Y, Auslender R, Abramovici H. Ripening and dilation of the unfavourable cervix for induction of labor by a double balloon device: experience with 250 cases. Br J Obstet Gynaecol . 1997;104:29-32. Atad J, Hallak M, Auslender R, Porat-Packer T, Zarfati D, Abramovici H. A randomized comparison of prostaglandin E2, oxytocin, and the double- balloon device in inducing labor. Obstet Gynecol . 1996;87(2):223-227. Sherman D, Frenkel E, Tovbin J, Arieli S, Caspi E, Bukovsky I. Ripening of the unfavorable cervix with extraamniotic catheter balloon: clinical experience and review. Obstet Gynecol Surv . 1996;51(10):621-627.
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