Comparison of the Effects of Traction Catheter and Normal Saline Amniotic Infusion on Cervical Ripening in Primiparous Women with A Bishop Score Less Than Four

Background and Objective: Cervical ripening plays a crucial role in the success of labor induction. When the Bishop score is less than 4, the use of cervical ripening methods becomes necessary. Various mechanical and pharmacological methods exist for this purpose, but the comparison of their effectiveness and safety remains a subject of debate. The present study aimed to compare the effects of traction catheters and extra-amniotic saline infusion (EASI) on cervical readiness in primiparous mothers with a Bishop score of less than 4 who were candidates for pregnancy termination. Materials and Methods: This single-blind randomized clinical trial was conducted on nulliparous women aged 18-35 years, with the gestational age of 37-42 weeks and Bishop scores less than 4, who were referred to the gynecology clinic of Ayatollah Mousavi Hospital in Zanjan City, Iran, in 2022. Women with a history of uterine surgery, active vaginal bleeding, rupture of membranes, and fetal anomalies were excluded from the study. The patients were randomly assigned to either the EASI or transcervical balloon catheter group. The time from oxytocin administration to complete dilation, duration of the second stage of labor, mode of delivery, patient satisfaction, maternal complications, and neonatal outcomes—including birth weight, Apgar scores at 1 and 5 minutes, and need for NICU admission—were recorded. Results: The average age of participants was approximately 27.4. Neonatal outcomes, including Apgar scores and birth weight, indicated no significant differences (P>0.05). However, post-intervention Bishop scores were significantly higher in the traction group compared to the EASI group (P=0.03). A significant difference was observed in the Bishop score before and after intervention in the EASI and traction group (P<0.05). Moreover, satisfaction levels were significantly lower in the EASI group compared to the traction group (P=0.002). Conclusion: The study concluded that maternal and neonatal complications were similar between the EASI and traction groups. Due to the better clinical outcomes and higher satisfaction levels associated with the traction method, it is recommended as the preferred approach for primiparous women.