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Obstetrics and Gynecology

Training Level

Resident PGY 4


Henry Ford Wyandotte


Obstetrics: Original ResearchComparison of single-balloon with double-ballon transcervical catheters and the incidence of altered fetal presentationJoshua Lupton, DO, Henry Ford Wyandotte Hospital, Wyandotte MIOBJECTIVE: To determine whether double-balloon transcervical catheters used for cervical ripening are associated with an increased incidence of altered fetal presentation in comparison with single-balloon transcervical catheters. STUDY DESIGN: We performed a retrospective study of women who had received either a single-balloon transcervical catheter (foley catheter) or a double-balloon transcervical catheter (Cook cervical ripening balloon, Cook Medical) for cervical ripening between August 2013 and December 2017 in a single healthcare system (Henry Ford Healthcare) consisting of three different hospitals. 1378 women received mechanical ripening with the type of balloon catheter used being recorded as either Foley catheter (n = 775) or Cook catheter (n = 603). All fetuses were sonographically confirmed to be in cephalic presentation prior to cervical ripening. Maternal age and BMI, amniotic fluid index, neonatal birth weight, fetal presentation, and mode of delivery were recorded. An a priori power analysis was performed using 80 percent power to detect a 5 percent difference between the two catheter types. Categorical data were summarized as counts and percentages, and numerical/continuous data as means with corresponding standard deviations. Between-group mean differences were compared by calculating t-tests for independent measures. Categorical data were compared using the chi-square test for association or Fisher’s exact test. Throughout this study, a p-value <0.05 (two-tail) was considered statistically significant. Following initial data entry using Microsoft Excel, Minitab Statistical Software (State College, PA) or Langsrud on-line calculator ( were used for performing the analyses.RESULTS: There were 2 cases of altered fetal presentations among the 776 patients who received a foley catheter (0.26%) and 4 cases among the 603 patients who received a Cook catheter (0.66%). The between-group difference was not statistically significant (p = 0.41). There was no statistically significant difference in age (p = 0.54). Patients who received a Cook catheter tended to have a higher BMI (p = 0.002), higher AFI (p = 0.016) and lower neonatal birth weight (p = <0.001). CONCLUSION: The double-balloon transcervical catheter is not associated with a statistically significant increased risk of altering fetal presentation compared with single-balloon catheters for cervical ripening.Authorship:Joshua Lupton, DO, Henry Ford Hospital - Wyandotte.Robert Jarski, PhD, PA, School of Health Sciences Oakland University.Gregory Goyert, MD, Henry Ford Hospital - Detroit.

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Comparison of Single-Balloon with Double-Ballon Transcervical Catheters Used for Cervical Ripening and the Incidence of Altered Fetal Presentation