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Poster Session 4

Category: Labor

Poster Session 4

(1131) Risk of infection using cervical ripening balloon for premature rupture of membranes: Systematic review meta-analysis

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Kamran Hessami, MD (he/him/his)

Baylor College of Medicine
Houston, Texas, United States

Coauthor(s)

ST

Sarah Tounsi, MD

Resident Physician
Baylor College of Medicine
Houston, Texas, United States
Mark A. Turrentine, MD

Professor
Department of Obstetrics and Gynecology Baylor College of Medicine
Houston, Texas, United States
Manisha Gandhi, MD (she/her/hers)

Professor
Baylor College of Medicine
Houston, Texas, United States

Objective:
To estimate the rate of intra-amniotic infection (IAI) in the setting of premature rupture of membranes (PROM) with usage of cervical ripening balloon (CRB) compared with oxytocin and/or prostaglandin for cervical ripening for induction of labor.

Study Design:
A systematic review and meta-analysis was conducted using terms related to CRB induction from database inception to 7/1/2025 and registered in Prospero (CRD420251085355). Randomized controlled trials (RCTs) and cohort studies comparing CRB with pharmacologic ripening (either prostaglandin or oxytocin) were included. The primary outcome was clinical diagnosis of IAI. The secondary outcomes were rates of cesarean delivery, maternal fever, and postpartum endometritis. The random-effects model was used to pool the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs).

Results:
Fourteen studies (7 RCTs and 7 cohort) involving 2,137 participants were included. The rate of IAI was similar between individuals undergoing ripening with CRB as compared to prostaglandin, 6.3% vs 4.4%, respectively (OR 1.23 [95% CI: 0.49, 3.09], I²: 61.8%) and CRB compared to oxytocin, 10.8% vs 7.3%, respectively (OR 1.69 [95% CI: 0.83, 3.43], I² = 26.4%). Separate subgroup analysis based on study design (RCT vs cohort) was performed which showed similar results (Figure 1). The secondary outcomes were similar between the CRB and pharmacologic ripening groups (Figure 2).

Conclusion:
Rates of IAI were similar in patients with PROM that underwent cervical ripening with CRB compared to pharmacologic methods. Due to the lack of adequate power to rule out a type II error in the current pooled analysis, future studies are needed before one method can be recommended over the other.