Cervical Ripening Balloon Midwifery Educators Objectives To - - PowerPoint PPT Presentation

Midwifery Educators

Cervical Ripening Balloon

• To understand the action of the cervical ripening

balloon

• Discuss the technique of insertion and removal of the

cervical ripening balloon

Objectives

• The cervical ripening balloon catheter is a

device designed to mechanically accelerate cervical dilation prior to induction of labour with amniotomy and syntocinon infusion.

What is it?

• 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...

How does it work?

• Safely ripens and dilates the cervix without

pharmaceuticals

• Eliminates the potential side effects of repeat

medications

• Easily placed and quickly removed

Why choose this method?

• 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

Contraindications

• 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

Prior to procedure

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

Equipment

• 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

• Inflate the uterine

balloon with 30-40 mL

• f sterile water. Spiggot
• r clamp (using

umbilical cord clamp) the catheter. Gently withdraw the catheter until it rests at the level

• f 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

Procedure cont.

• Deflate the balloon at 12-18 hours
• Gently remove catheter from vagina

Removal of the balloon

Atad J, Hallak M, Ben-David Y, Auslender R, Abramovici H. Ripening and dilation

• f 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.

References