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Recording available 2/16-5/2

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Poster Session 3

Category: Labor

Poster Session 3

(918) Not All Ripened Are Delivered Equal: Cesarean Clues Revealed

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Coauthor(s)

Anne-Sophie van Wingerden, MD

Resident Physician
University of Massachusetts Chan Medical School
University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States
Heidi K. Leftwich, DO

Associate Professor of Obstetrics and Gynecology
UMass Chan Medical School
Worcester, Massachusetts, United States

Submitting Author and Presenting Author(s)

Rachel Shamoun, MD

Maternal Fetal Medicine Fellow
UMass Chan Medical School
Worcester, Massachusetts, United States

Coauthor(s)

VC

Vanessa Chin, BS

UMass Chan Medical School
UMass Chan Medical School, Massachusetts, United States

Objective:
To identify factors associated with cesarean delivery among patients undergoing cervical ripening for labor induction.

Study Design:
This was a retrospective cohort study of patients undergoing induction of labor with cervical ripening at a single academic institution from 1/1/2020 to 12/31/2021. Inclusion criteria were singleton gestation, gestational age ≥37 weeks, and available pre-pregnancy BMI. Exclusion criteria included prior cesarean delivery, underweight BMI (< 18.5), pre-gestational diabetes, significant fetal anomalies, and intrauterine fetal demise. Cervical ripening typically followed institutional guidelines recommending dual-agent therapy (cervical balloon plus pharmaceutical agent). The primary outcome was mode of delivery. Associations between demographic and clinical factors and cesarean delivery were evaluated using descriptive statistics and multivariable analysis.

Results:
Of 5712 charts reviewed, 1924 met inclusion criteria. Among this cohort, factors significantly associated with increased risk of cesarean delivery included nulliparity, minimal cervical dilation at initiation of ripening, and absence of cervical balloon use. In contrast, multiparity and the use of dual-agent cervical ripening were associated with a higher likelihood of vaginal delivery. In both multiparity and nulliparity, total ripening time was longer in those that delivered via cesarean. These findings suggest that both patient characteristics and modifiable clinical practices can impact cesarean risk during induction.

Conclusion:
Nulliparity, limited cervical dilation, and lack of balloon catheter use were associated with increased cesarean rates in patients undergoing cervical ripening. Notably, absence of cervical balloon use—a modifiable factor—was linked to higher cesarean risk, highlighting the importance of adherence to standardized induction protocols. Findings support continued evaluation of induction practices and patient education to promote evidence-based decision-making and reduce primary cesarean births, especially among rising public scrutiny of induction methods via social media platforms.