Intracervical Balloon Placement and the Risk of Chorioamnionitis in Term Rupture of Membranes
Abstract
INTRODUCTION: To evaluate whether cervical ripening in patients with term premature rupture of membranes (PROM) through intracervical balloon placement increases the risk of chorioamnionitis when compared with women with term PROM ripened with other methods.
METHODS: Retrospective cohort study of term singleton gestations with PROM delivered July 2009 to June 2012. Exposure of interest was intracervical balloon placement. Primary outcome of interest was chorioamnionitis. Demographic and labor characteristics were compared between groups. Statistical analysis included bivariate and multivariate techniques.
RESULTS: One hundred twenty-nine term patients with PROM were identified as eligible: 43 were ripened by an intracervical balloon (33.3%) and 86 were ripened with either intravenous oxytocin (n=82 [63.6%]) or intravaginal misoprostol (n=4 [3.1%]). A higher number of women who were ripened with an intracervical balloon were nulliparous (n=36 [83.7%] intracervical balloon compared with n=48 [55.8%] other methods, P=.002). There was a trend toward a higher rate of chorioamnionitis in women ripened with an intracervical balloon compared with other methods (P=.066). shows a higher rate of cesarean delivery, intrauterine pressure catheter use, median length of membrane rupture, and active labor in women ripened with an intracervical balloon. After adjustment, chorioamnionitis was not explained by intracervical balloon placement but by nulliparity (adjusted odds ratio [OR] 5.26, 95% confidence interval [CI] 1.25-22.1, P=.02) and intrauterine pressure catheter use (adjusted OR 2.92, 95% CI 1.02-8.32, P=.045).(Table is included in full-text article.)
CONCLUSIONS: : The rate of chorioamnionitis, although higher in women induced with an intracervical balloon, was explained by nulliparity and intrauterine pressure catheter use. Future prospective studies are needed to evaluate the potential contribution of intracervical balloon and intrauterine pressure catheter use toward the development of chorioamnionitis in women with term PROM.