Meta-analysis: Balloon Cervical Ripening Not Linked to Higher Uterine Rupture Risk in TOLAC

A systematic review and meta-analysis of 18 nonrandomized studies and two randomized trials (28,035 observations, including 5,516 balloon exposures) examined transcervical balloon cervical ripening before trial of labor after cesarean. The analysis found no increased odds of complete uterine rupture with balloon-based induction compared with spontaneous labor or oxytocin alone, and lower odds compared with prostaglandin induction (OR 0.43 vs prostaglandins; OR 0.40 across all pharmacologic comparators), though dehiscence was reported more often after balloon-based induction than spontaneous labor. The authors note that because amniotomy or oxytocin almost always followed balloon placement, these estimates reflect a balloon-based strategy rather than the catheter alone, and rate overall certainty of evidence as very low.

Most relevant for: Pregnant patients undergoing trial of labor after a prior low-transverse cesarean delivery who require labor induction.

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