Double-balloon versus single-balloon catheter for cervical ripening and labor induction: A systematic review and meta-analysis

We searched Embase, PubMed and the Cochrane Library for randomized or quasi-randomized controlled trials to compare the use of single-balloon to double-balloon catheters. The risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) was calculated using fixed-effects or random-effects models. Four studies involving a total of 793 pregnant women were included. There were no significant differences in the rate of cesarean (RR1.09, 95% CI 0.86, 1.38; P=0.48), or vaginal deliveries within 24h (RR0.94, 95% CI 0.82, 1.09; P=0.42), the mean time to delivery (MD0.39, 95% CI -0.90, 1.68h; P=0.55) or Bishop score improvement (MD0.62, 95%CI -0.18, 1.42; P=0.13) between the groups. Women who received the double-balloon catheter had a similar risk of maternal intrapartum fever and post-partum hemorrhage. Pain during ripening was only reported in one trial and was significantly higher with the double balloon, whereas pain during device insertion was measured in two trials: one reported no difference while the other reported significantly increased pain with the double balloon. The double-balloon and single-balloon (Foley) catheters had similar effectiveness and safety. The Foley catheter is significantly cheaper, widely available and accessible, has a longer history of use and remains the logical choice over the double-balloon catheter for cervical ripening.