Induction of labour: should we prefer balloons to prostaglandins?

We will discuss Double-balloon catheter versus prostaglandin E2 for cervical ripening and labour induction by Du and co-authors on the 25th January for 7 days.

This paper is open access:

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Start date: 25 January 2017 (the discussion will continue for 7 days between 25th January and 1st February 2017.

First hosted discussion session(s) on Twitter starts at GMT 8pm (3pm EST/12 noon PST) on 25 January 2017 (using hashtag #BlueJC).

Host: @BlueJCHost

Platforms: Twitter, Facebook and LinkedIn 

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues.

The discussion points are attached below:




A 26 year old woman in her first pregnancy requires induction of labour at term for reduced fetal movements.   She has a normal CTG, normal scan with normal umbilical artery Doppler studies, and no other risk factors.

What method of induction of labour would you recommend? 

Description of Research:

Participants Women with singleton pregnancies with live fetuses in vertex presentation, intact membranes, and unfavourable cervices, requiring induction of labour.
Intervention Transcervical double balloon catheter
Comparison Locally applied prostaglandin E2 analogues
Outcomes Primary:  (1) proportion of women achieving vaginal delivery within 24 hours, (2) proportion of women delivering by Caesarean

Secondary: (1) Uterine hyperstimulation; (2) Neonatal unit admission; (3) Maternal adverse events (PPH, uterine rupture).

Study design Metanalysis of randomised controlled trials



Discussion Points:

  • How do you currently counsel women similar to the one in the scenario?
  • Have you used double-balloon catheters? Do you find that they are well tolerated?
  • How did the authors assess the quality of individual studies?
  • What were the problems identified by their quality assessment of individual studies?
  • Critically appraise this meta-analysis using the PRISMA checklist (
  • Can you briefly summarise the results of this study as a one-sentence take-home message?
  • Would the results of this study influence your management of the woman in the scenario?
  • How would the results of this study influence your daily practice?


Suggested reading

Scottish Intercollegiate Guidelines Network. Critical Appraisal: notes and checklists. Methodology checklist 1: Systematic reviews and meta-analyses. (Last access 20 July 2016)