A comparison of maternal satisfaction with the use of osmotic dilators as opposed to balloons as a method of induction of labour: A literature review

Abstract

Introduction and objective: This thesis investigates whether the use of osmotic dilators as a method of mechanical induction of labour leads to increased maternal satisfaction when compared to balloon inductions at term. Background: Up to 25% of births (185,000 pregnancies) are induced every year in Ger-many, using a range of pharmacological or mechanical methods. Pharmacological methods can lead to uterine hyperstimulation, requiring increased monitoring and inpatient manage-ment. Mechanical methods ripen the cervix through the endogenous release of hormones and can be managed in an outpatient setting. Most research concentrates on obstetric out-comes with little to no focus on maternal satisfaction. Method: A literature review was conducted in September and October 2023 searching for keywords in the databases PubMed, CINAHL and Scopus, using current clinical guidelines and the principle of snowballing. Studies were included for review if they focussed on ma-ternal satisfaction. Ten studies (eight RCTs and 2 cohort studies) are critically assessed in this thesis. Results: Balloons and osmotic dilators are safe, effective, and accepted methods of me-chanical cervical ripening. Their use is associated with higher maternal satisfaction when compared with pharmacological agents. In direct comparison osmotic dilators are superior to balloons in the areas of sleep, relaxing time and performance of daily activities. Discussion: Most studies compare balloons and osmotic dilators with pharmacological agents; only few compare the mechanical methods with each other and, even fewer focus on satisfaction as an outcome. Conclusions: There is currently insufficient evidence to categorically show the superiority of osmotic dilators over balloons. Further research is recommended looking specifically at direct comparisons between the Cook double balloon and Dilapan-S, focussing on stand-ardised measurements of satisfaction as well as the acceptance of outpatient management. Providing evidence-based choices in cervical ripening procedures can facilitate shared de-cision making and ultimately lead to an increase in maternal satisfaction.