Cook Cervical Ripening Balloon - PowerPoint PPT Presentation

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Cook Cervical Ripening Balloon

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  1. Cook Cervical Ripening Balloon • Product information • 18Fr, 40 cm • Dual 80 ml balloons • 100% Silicone • Box of 10 • J – CRB – 184000 or G48149

  2. Advantages of this balloon over other methods include • It is particularly successful in women with unfavourable cervices • It is non pharmacological, so does not cause hyperstimulation • It is relatively easy to insert • Reduces the need for multiple vaginal examinations • Reduced the need for continuous monitoring • Increases the chances of vaginal delivery by producing a primed dilated cervix for ARM • Can be used for women with IUD 3rd trimester IUDS reducing the need for multiple vaginal examinations

  3. Disadvantages • May require a doctor to insert in lithotomy position • Catheter remains for 12 – 24 hours which may be unacceptable to women

  4. Contra – indications • Patients receiving or planning to undergo exogenous prostaglandins • Placenta previa / vasa previa or placenta accerta • Transverse lie / breech / head above the pelvic brim • Ruptured membranes • Severe maternal / fetal compromise ( e.g. PET requiring urgent delivery ) • Multiple gestation • Polyhydramnios • Abnormal fetal heart rate changes • Any contraindication to induction of labour • Active genital herpes • Invasive cervical cancer • Pelvic structural abnormality • Previous hysterotomy / uterine perforation / myomectomy traversing the myometrium

  5. Cautions • Must not be left for more than 24 hours • Must be used with care in women with previous caesarean section • If fetal membranes rupture whilst the CCRB is in situ then it must be removed and plan of management discussed with the consultant on call • Must not be used in women who have recently been given prostaglandins ( < 12 hours ) as this accentuates the adverse events associated with their use • Hyperstimulation • Impaired utero – placental circulation • Tachysystole • Uterine rupture • Amniotic fluid embolism • Pelvic pain • Retained placenta • Genital bleeding shock • Bradycardia

  6. Setting up for cooks cervical ripening balloon insertion • Equipment • Syringes 60ml ×4 • Needle 16 gauge needle • Vaginal pack • Sponge holder × 1 • Normal saline bags 100ml ×2 • Cook cervical ripening balloon • Disposable speculum • Water / aqueous savlon solution to clean

  7. Patient preparation 1- the patient is brought to labour ward 2- once a normal CTG is obtained the doctor is informed to insert the balloon 3-confirm presentation / placental localization with abdominal ultrasound 4- place the patient on the left lateral position / lithotomy position 5-Insert large vaginal speculum to gain cervical access 6- Clean the cervix with the appropriate cleaning solution to prepare for device insertion

  8. Device insertion • Insert the device and advance both balloon into the cervical canal • Inflate the internal balloon with 40ml of normal saline through the check flow valve u ( red) • Once inflated pull back until balloon rests against the internal os • The vaginal balloon is now inflated to 40ml through check flow valve v (green) • Once on either side of the cervix and device the speculum is removed • Add more fluid into each balloon until both balloons are filled to 80mls each • Do not over inflate the balloon • Taped to patients leg • Remove after 12-24 hours

  9. Procedure for removal of the balloon and after • 12- 24hours later the balloon is removed , this is done by removing fluid from both balloon . • The patient dose not need to be placed in lithotomy for this . • Once the balloon is removed, an ARM should be done soon after. • If not contracting within one hour, then an oxytocin infusion should be commenced. • In the event that the head is high ARM should be avoided until the head is lower in the pelvis . • Consideration for commencement syntocinon with intact membranes

  10. PGE 2 , Oxytocin , Ripening Balloon • Results • Balloon and PGE2 Were comparable - Change in Bishop score – 5 - Interval to delivery - 20 hours - Cesarean Rate • Both methods were superior to oxytocin

  11. PGE 2 , Oxytocin , Ripening Balloon • Results • Balloon was superior to both PGE2 & Oxytocin - Cervical Dilation - > 3cm in > 90% of patients - Failure Rate - < 10% • Compared to over 20% for PGE 2 & 50% for oxy