Labour induction: effectiveness of a standardized protocol using balloon catheter as first-line cervical ripening, a before-and-after study.

OBJECTIVES: This study aimed to evaluate whether the implementation of a standardized labour induction protocol using a balloon catheter as the first-line cervical ripening method was associated with an increased rate of vaginal delivery within 24 hours. METHODS: A retrospective before-after study was conducted in a French tertiary maternity unit. The "Before" period (November 2023-April 2024), during which the choice of cervical ripening method was left to the discretion of the attending obstetrician, was compared with the "After" period (November 2024-April 2025) following the implementation of a standardized protocol using a balloon catheter as the first line cervical repening method in November 2024. We included women with singleton term pregnancies in cephalic presentation requiring induction of labour with an unfavorable cervix. The primary outcome was vaginal delivery within 24 hours. Maternal satisfaction during the "After" period was assessed using the EXIT questionnaire. RESULTS: A total of 402 women were included ("Before": n=197, "After": n= 205). No significant difference was found regarding vaginal delivery within 24 hours (34,0 % vs 27,3 %, p = 0,18). Caesarean delivery rates, maternal complications, and neonatal outcomes were not different between groups. Nighttime epidural analgesia placement was significantly less frequent in the "After" group (35.6% vs 46.2%, p = 0.008). Among respondent women, 77.4% agreed or strongly agreed with the statement, "Overall, I am satisfied with my childbirth experience." CONCLUSIONS: Implementation of a standardized cervical ripening protocol using a balloon catheter as first-line was not associated with a higher rate of vaginal delivery within 24 hours. However, the protocol may improve care organization by reducing nighttime epidural placements.