Case Series of Labor Induction inTwin Gestations with an IntrauterineBalloon Catheter

Abstract

The efficacy and safety of labor induction using an intrauterine balloon catheter in twin pregnancies has been evaluated. During the study period (1992–1997), labor was induced at 36–42 weeks in 17 twin gestations. Labor induction was indicated for preeclampsia (n = 10), birth weight discordance (n = 3), suspected fetal distress (n = 2) and postdates (n = 2). Twin A was in vertex presentation in all cases. An intrauterine balloon catheter was inserted transcervically followed by augmentation whenever required. Vaginal delivery was achieved in 15 (88.2%) patients. The mean interval from balloon insertion to delivery was 17.05 h, with 80% deliveries occurring within 24 h of catheter insertion and 80% occurring within 12 h of catheter expulsion. Birth weight was 2,514 ± 244 and 2,421 ± 367 g for twin A and B, respectively. Oxytocin was required in 4 patients. Postpartum hemorrhage was noted in 1 patient. One patient with no progress of labor and 1 with suspected intrapartum fetal distress required cesarean section. All neonates had a 5-min Apgar score of 10. The data suggest that an intrauterine balloon catheter appears to be safe and effective to induce labor in twin gestations.

Gestational Duration, and Fetal and Infant Mortality for Twins vs Singletons

“…At term or near term, a more appropriate treatment may be labor induction (Manor et al, 1999). The present figures make it possible to estimate the number of labor induction in pregnancies needed in order to avoid fetal death (Table 1).…”

Is misoprostol safe for labor induction in twin gestations?

“…There have been four studies of labor induction in twins using oxytocin [10], oral PGE 2 [19], intrauterine Foley balloon [20] and a All values are expressed as n (%) or mean + standard deviation. NS ¼ not significant.…”

Intrapartum Management of Twins: Truths and Controversies

“…Induction techniques used included oxytocin (18), vaginal prostaglandins (6), and intrauterine balloon catheters (12). No significant differences were observed in mean labor times, the rate of maternal infection, fetal distress, vaginal delivery, operative vaginal delivery, and cesarean section.…”

“…The use of extra-amniotic balloon placement devices has been associated with an increased risk of malpresentation of the presenting twin [11]; however, this risk also remains a theoretical concern, because no corroborating publications can be found. Manor and colleagues [12] published a case series including 17 patients with twin gestations who underwent induction of labor between 36 to 42 weeks using an intrauterine balloon catheter. Indications for induction included pre-eclampsia (10), discordance (3), suspected fetal distress (2), and postdates (2).…”