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

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. Plain Language Summary: Why was this Study Done? When pregnancy continues beyond 41 weeks, doctors often need to induce labor to reduce risks for the mother and baby. One common method uses a double-balloon catheter, which gently opens the cervix. This method can be used alone or together with medicines such as oxytocin, dinoprostone, or misoprostol. However, it is still unclear which approach gives the best balance between effectiveness and safety. What did the Researchers Do? We studied 1,022 women with pregnancies of 41 weeks or more who needed labor induction. We compared four approaches: double-balloon catheter alone, double-balloon catheter with oxytocin, double-balloon catheter with dinoprostone, and double-balloon catheter with misoprostol. We examined delivery timing, vaginal birth within 24 hours, cesarean delivery, and complications in mothers and neonates. What did the Researchers Find? The double-balloon catheter with misoprostol was linked with the shortest median time to vaginal birth and a high rate of vaginal birth within 24 hours. However, this group also had more maternal complications, including abnormal uterine contractions, fever or infection during labor, poor uterine contraction after birth, and blood transfusion. The double-balloon catheter with oxytocin showed the most balanced pattern between effectiveness and safety. The double-balloon catheter with dinoprostone was linked with slower labor progress and more cesarean deliveries. What do these Results Mean? For women needing labor induction after 41 weeks, the best method may depend on maternal risk, urgency of delivery, and the hospital’s ability to monitor labor closely. Infographic on late-term pregnancy induction: efficiency, morbidity and cesarean predictors.The infographic presents a study on induction protocols for late- and post-term singleton cephalic pregnancies with a Bishop score of 6 or less, involving 1,022 cases in a retrospective cohort study. Four induction protocols are compared: DBC alone (234 cases), DBC plus oxytocin (246 cases), DBC plus dinoprostone (238 cases) and DBC plus misoprostol (304 cases). Comparative findings show DBC plus misoprostol has the greatest efficiency but highest maternal morbidity. DBC plus oxytocin is effective with a balanced profile. DBC plus dinoprostone is a pharmacomechanical option. Clinical messages highlight misoprostol’s efficiency and oxytocin’s balanced profile. Protocol choice should balance efficiency, safety and monitoring. Higher estimated fetal weight is the only independent predictor of cesarean delivery. Keywords: labor induction, prolonged pregnancy, balloon catheter, misoprostol, dinoprostone, oxytocin