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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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 hours

11. 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

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

15. 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