Comparative Study on Effect of Hygroscopic Dilators Versus Foleys Balloon Catheter Insertion on Outcome of Preinduction of Labour: Prospective Study

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S. Suganthi
S. Saranya
G. Kuppulaksmi
Suganya Asaithambi


Introduction: A procedure to artificially start uterine contractions that eventually cause cervix to elongate and efface is known as inducing labor. The infant should therefore preferably be delivered vaginally.

Before initiating induction, it is important to confirm gestational age and fetal lung maturity.

Labor induction is one of the interventions that is most frequently utilized today. Up to 20% of women worldwide have labor that is induced using one of two methods. “The advancement in oxytocics and induction techniques has made the process of induction easier, safer, more efficient, and predictable compared to the older methods”2.


To calculate the impact of hygroscopically dilators on uterine cervix ripening.

To research the progression and results of labor during hygroscopically induced labor.

To calculate the impact of the Foley catheter on uterine cervix ripening.

To examine the progression and results of labor when it is induced using a Foley catheter.

In the context of labor induction, the goal is to assess how hygroscopic dilators and the Foley catheter affect cervical dilation, the length of induction, maternal outcomes, and fetal outcomes.


The prospective study was carried out at Chennai's Government RSRM Lying In Hospital between December 2018 and September 2019. For 120 patients who were term pregnant moms eligible for induction, Bishop scores were determined. If the bischop score was less than 6, they were randomly assigned to the hygroscopic dilator group and the foleys group. Between these 2 group, analyses and comparisons of patient characteristics and outcomes were made. The mode of delivery was the study's main endpoint. “Measured and analyzed secondary outcomes included post-insertion bishop score, insertion delivery interval, induction delivery interval, apgar at 1 and 5 minutes, and need for PGE2 gel”3.


Compared to 71.7%  in control group, 73.3% in study group experienced natural labor (p value = 0.838). 20% of the study group underwent emergency LSCS, compared to 26% of the control group (p value = 0.387). Consequently, the major result between these groups does not differ statistically from the other groups.

In comparison to 60.5% of instances in the control group, the insertion delivery interval was between 12 and 24 hours in 77.1% of patients with primi (p value = 0.025).

“For Multigravida insertion delivery interval is 12 to 24 hours in study group in 80% of instances, 12 to 24 hours in study group in 40.9% of cases, and more than 24 hours in 40.9% of cases”4. The gap between induction delivery was insignificant (p value = 0.671). In 10% of instances in the research group and 31.7% of cases in the control group, no PGE 2 gel was applied. In the study group, one gel was utilized in 76.7% of instances, two gels in 11.7%, and three gels in 1.7% of cases.

One gel was used in 36% of cases and two gels in 5% of instances in the control group. The difference between the study group's and control group's use of PGE 2 gel is statistically significant. “The study group and control group do not show a statistically significant difference (p value = 0.120) in the 1- and 5-minute Apgar scores”6. However, there is a significant statistical difference (p value = 0.033) between the post-insertion Bishop scores of  study group and control group, with the former having higher scores.


Dilapan S has preinduction results that are safe and comparable to those of a foleys balloon catheter when used at term.

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S. Suganthi, S. Saranya, G. Kuppulaksmi, & Suganya Asaithambi. (2023). Comparative Study on Effect of Hygroscopic Dilators Versus Foleys Balloon Catheter Insertion on Outcome of Preinduction of Labour: Prospective Study. Journal of Coastal Life Medicine, 11(1), 2075–2086. Retrieved from


Induction of labour. Evidence based clinical guideline No 9. Royal College of Obstetricians and Gynaecologists, 2001. Pp39-40.

Macones GA. Elective induction of labor: waking the sleeping dogma?. Annals of internal medicine. 2009 Aug 18;151(4):281-2.

Rayburn WF, Zhang J. Rising rates of labor induction: present concerns and future strategies. Obstetrics & Gynecology. 2002 Jul 1;100(1):164-7.

RCOG. Royal College of Obstetricians and Gynaecologists. Induction of labour. 2008;1:1-12,5:45-68

Nuutila M, Halmesmäki E, Hiilesmaa V, Ylikorkala O. Women's anticipations of and experiences with induction of labor. Acta obstetricia et gynecologica Scandinavica. 1999 Jan 1;78(8):704-9.

Out JJ, Vierhout ME, Verhage F, Duivenvoorden HJ, Wallenburg HC. Characteristics and motives of women choosing elective induction of labour. Journal of psychosomatic research. 1986 Jan 1;30(3):375-80.Mozurkewich EL, Chilimigras JL, Berman DR, Perni UC, Romero VC, King VJ, Keeton KL. Methods of induction of labour: a systematic review. BMC pregnancy and childbirth. 2011 Dec;11(1):84.

Caughey AB, Sundaram V, Kaimal AJ, Gienger A, Cheng YW, McDonald KM, Shaffer BL, Owens DK, Bravata DM. Systematic review: elective induction of labor versus expectant management of pregnancy. Annals of internal medicine. 2009 Aug 18;151(4):252-63.

Alexander JM, MCIntire DD, Leveno KJ. Prolonged pregnancy: induction of labor and cesarean births. Obstetrics & Gynecology. 2001 Jun 1;97(6):911-5.

Rand L, Robinson JN, Economy KE, Norwitz ER. Post-term induction of labor revisited. Obstetrics & Gynecology. 2000 Nov 1;96(5):779-83.

O’Brien WF. The role of prostaglandins in labor and delivery. Clinics in perinatology. 1995 Dec 1;22(4):973-84.

Fuchs AR, Goeschen K, Husslein P, Rasmussen AB, Fuchs F. Oxytocin and the initiation of human parturition: III. Plasma concentrations of oxytocin and 13, 14- dihydro-15-keto-prostaglandin F2α in spontaneous and oxytocin-induced labor at term. American journal of obstetrics and gynecology. 1983 Nov 1;147(5):497-502.

Bishop EH. Pelvic scoring for elective induction. Obstet Gynecol 1964; 24: 266- 268

Maul H, Mackay L, Garfield RE. Cervical ripening: biochemical, molecular, and clinical considerations. Clin Obstet Gynecol. 2006;49(3):551–563.

Sciscione AC. Methods of cervical ripening and labor induction: mechanical. Clinical obstetrics and gynecology. 2014 Jun 1;57(2):369-7

Rayburn WF. Preinduction cervical ripening: basis and methods of current practice.

Obstetrical & gynecological survey. 2002 Oct 1;57(10):683-92.

Sooranna SR, Lee Y, Kim LU, Mohan AR, Bennett PR, Johnson MR. Mechanical stretch activates type 2 cyclooxygenase via activator protein‐1 transcription factor in human myometrial cells. Molecular human reproduction. 2004 Feb 1;10(2):109- 13.

Mohan AR, Sooranna SR, Lindstrom TM, Johnson MR, Bennett PR. The effect of mechanical stretch on cyclooxygenase type 2 expression and activator protein-1 and nuclear factor-κB activity in human amnion cells. Endocrinology. 2007 Apr 1;148(4):1850-7.

Johnson N. Intracervical tents: usage and mode of action. Obstet Gynecol Surv. 1989;44(6):410–420

Norström A1, Bryman I, Hansson HA. Cervical dilatation by Lamicel before first trimester abortion: a clinical and exper- imental study. Br J Obstet Gynaecol. 1988;95(4):372–376.

Gelber S, Sciscione A. Mechanical methods of cervical ripen- ing and labor induction. Clin Obstet Gynecol. 2006;49(3):642–657

Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M. Mechanical methods for induction of labor. Cochrane Database Syst Rev. 2012:3:CD001233.

Gower RH, Toraya J, Miller JM Jr. Laminaria for preinduction cervical ripening. Obstet Gynecol. 1982;60(5):617–619

Gilson GJ, Russell DJ, Izquierdo LA, Qualls CR, Curet LB. A prospective randomized evaluation of a hygroscopic cervical dilator, dilapan, in the preinduction ripening of patients undergoing induction of labor. Am J Obstet Gynecol. 1996;175 (1):145–149

Blumenthal PD, Ramanauskas R. Randomized trial of dilapan and laminaria as cervical ripening agents before induction of labor. Obstet Gynecol. 1990;75(3):365–368.

Chua S, Arulkumaran S, Vanaja K, Ratnam SS. Preinduction cervical ripening: prostaglandin E2 gel vs hygroscopic mechanical dilator. J Obstet Gynaecol Res. 1997;23(2):171–177.

Johnson IR, Macpherson MB, Welch CC, Filshie GM. A com- parison of Lamicel and prostaglandin E2 vaginal gel for cervical ripening before induction of labor.

Am J Obstet Gynecol. 1985;151(5):604–607.

Sanchez-Ramos L, Kaunitz AM, Connor PM. Hygroscopic cervical dilators and prostaglandin E2 gel for preinduction cervical ripening. A randomized, prospective comparison. J Reprod Med. 1992;37(4):355–359.

Hibbard JU, Shashoua A, Adamczyk C, Ismail M. Cervical ripening with prostaglandin gel and hygroscopic dilators. Infect Dis Obstet Gynecol.


Turnquest MA, Lemke MD, Brown HL. Cervical ripening: randomized comparison of intravaginal prostaglandin E2 gel with prostaglandin E2 gel plus Laminaria tents. J Matern Fetal Med. 1997;6(5):260–263.

Roberts WE, North DH, Speed JE, Martin JN, Palmer SM, Morrison JC. Comparative study of prostaglandin, laminaria, and minidose oxytocin for ripening of the unfavorable cervix prior to induction of labor. J Perinatol. 1986;6:16–19.

Lyndrup J, Legarth J, Dahl C, Philipsen T, Eriksen PS. Lamicel does not promote induction of labour. A randomized con- trolled study. Eur J Obstet Gynecol Reprod Biol. 1989;30(3): 205–208.

Lin A, Kupferminc M, Dooley SL. A randomized trial of extra- amniotic saline infusion versus laminaria for cervical ripening. Obstet Gynecol. 1995;86(4):545– 549.

Heinemann J, Gillen G, Sanchez-Ramos L, Kaunitz AM. Do mechanical methods of cervical ripening increase infectious morbidity? A systematic review. Am J Obstet Gynecol. 2008;199 (2):177–187.

Kazzi GM, Bottoms SF, Rosen MG. Efficacy and safety of laminaria digitata for preinduction ripening of the cervix. Obstet Gynecol. 1982;60(4):440–443.

Sierra T, Figueroa MM, Chen KT, Lunde B, Jacobs A. Hyper- sensitivity to laminaria: a case report and review of literature. Contraception. 2015;91(4):353– 355.

Atad J, Bornstein J, Calderon I, Petrikovsky BM, Sorokin Y, Abramovici H. Nonpharmaceutical ripening of the unfavorable cervix and induction of labor by a novel double balloon device. Obstet Gynecol. 1991;77(1):146–152.

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.

Suffecool K, Rosenn B, Kam S, Mushi J, Foroutan J, Herrera K. Labor induction in nulliparous women with an unfavorable cervix: double balloon catheter versus dinoprostone. J Perinat Med. 2014;42(2):213–218.

Shechter-Maor G, Haran G, Sadeh-Mestechkin D, Ganor-Paz Y, Fejgin MD, Biron-Shental T. Intra-vaginal prostaglandin E2 versus double balloon catheter for labor induction in term oligohydramnios. J Perinat. 2015;35(2):95–98.

Pennell CE, Henderson JJ, O’Neill MJ, McCleery S, Doherty DA, Dickinson JE. Induction of labour in nulliparous women with an ufavourable cervix: a randomised controlled trial compar- ing double and single balloon catheters and PGE2 gel. BJOG. 2009;116(11):1443–1452.

Salim R, Zafran N, Nachum Z, Garmi G, Kraiem N, Shalev E. Single balloon compared with double balloon catheters for induction of labor. Obstet Gynecol. 2011;118(1):79–86.

Peter EP Petros, Re: Global rising rates of caesarean sections, BJOG: An International Journal of Obstetrics & GynaecologyBJOG: An International Journal of Obstetrics & GynaecologyBJOG: An International Journal of Obstetrics & Gynaecology, 10.1111/1471-0528.16889, 129, 3, (512-513), (2021).

Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM; WHO Working Group on Caesarean Section. WHO Statement on Caesarean Section Rates. BJOG. 2016 Apr;123(5):667-70. doi: 10.1111/1471-0528.13526. Epub 2015 Jul 22. PMID: 26681211; PMCID: PMC5034743.

Das, Vinita, et al. "Increasing rates of cesarean section, an upcoming public health problem: an audit of cesarean section in a tertiary care center of North India based on Robson classification." International Journal of Reproduction, Contraception, Obstetrics and Gynecology, vol. 6, no. 11, Nov. 2017, pp. 4998+. Gale OneFile: Health and Medicine, Accessed 31 Dec. 2021.

World Health Organization Human Reproduction Programme, 10 April 2015. WHO Statement on caesarean section rates. Reprod Health Matters. 2015 May;23(45):149-50. doi: 10.1016/j.rhm.2015.07.007. Epub 2015 Jul 27. PMID: 26278843.

FIGO Working Group On Challenges In Care Of Mothers And Infants During Labour And Delivery. Best practice advice on the 10-Group Classification System for cesarean deliveries. Int J Gynaecol Obstet. 2016 Nov;135(2):232-233. doi: 10.1016/j.ijgo.2016.08.001. Epub 2016 Aug 22. PMID: 27609739.

Robson M. Classification of caesarean sections. Fetal Maternal Med Rev 2001; 12: 23– 39.

A Systematic Review of the Robson Classification for Caesarean Section: What Works, Doesn't Work and How to Improve It

Ana Pilar Betrán ,Nadia Vindevoghel,Joao Paulo Souza,A. Metin Gülmezoglu,Maria Regina Torloni

Published: June 3, 2014

Use of the Robson classification to assess caesarean section trends in tertiary hospital. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, [S.l.], v. 7, n. 5, p. 1796-1800, apr. 2018. ISSN 2320-1789. Available at: <>. doi:

Chaillet N, Dumont A. Evidence-based strategies for reducing cesarean section rates: a meta-analysis. Birth. 2007 Mar;34(1):53-64. doi: 10.1111/j.1523-536X.2006.00146.x. PMID: 17324180.

Zhang J, Landy HJ, Ware Branch D, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010;116(6):1281-1287. doi:10.1097/AOG.0b013e3181fdef6e