Double-Balloon Catheter Alone or Combined with Oxytocin, Dinoprostone, or Misoprostol for Labor Induction in Late- and Post-Term Pregnancies: A Retrospective Cohort Study

Abstract

Purpose: To compare the effectiveness and safety of double-balloon catheter (DBC) alone or combined with oxytocin, dinoprostone, or misoprostol for labor induction in late- and post-term pregnancies with unfavorable cervices. Patients and Methods: This single-center retrospective cohort study included 1022 women with singleton cephalic pregnancies at >= 41 weeks' gestation and a Bishop score <= 6 who underwent induction between November 2017 and February 2025. Women were managed with DBC alone (n=234), DBC plus oxytocin (n=246), DBC plus dinoprostone (n=238), or DBC plus misoprostol (n=304). The primary outcomes were induction-to-delivery interval, vaginal delivery within 24 hours, and delivery mode; secondary outcomes included maternal and neonatal complications. Group comparisons, Kaplan-Meier analysis, and multivariable regression were performed. Results: Induction outcomes differed significantly among protocols. Time-to-event analysis showed the shortest median time to vaginal delivery with DBC plus misoprostol (14.9 hours) and the longest with DBC plus dinoprostone (19.4 hours). Vaginal delivery within 24 hours was most frequent with DBC plus misoprostol and DBC alone. DBC plus dinoprostone had the highest cesarean delivery rate. Maternal complications were more frequent with DBC plus misoprostol, particularly uterine hyperstimulation, intrapartum fever/clinical chorioamnionitis, postpartum atony, and blood transfusion. Neonatal outcomes were largely comparable, although umbilical artery pH was slightly lower in the DBC plus misoprostol group. Estimated fetal weight was the only independent predictor of cesarean delivery. Conclusion: Among DBC-based induction strategies, DBC plus misoprostol appeared most efficient but had a less favorable maternal safety profile. DBC plus oxytocin offered the most balanced effectiveness-safety profile, whereas DBC plus dinoprostone was associated with slower labor progression and less favorable operative outcomes. Protocol selection should be individualized according to maternal risk, urgency of delivery, and available intrapartum monitoring capacity.