Obstetrical History: Labor induction, Part 4

Induction of labor sparked no end to the creativity of inventiors. one was the the Rubber Bag in Cervix by Barnes in 1861. It's always been known that in ordered to induce labor the cervical barrier had to be breeched. To that end any number of devices were induced through the cervix to produce labor, the most renowned early device being the "colpeurypters" of early Brown (1851). It became a practice in the middle 20th century to use inflated devices, and was generally accepted that use of inflated balloons to induce cervical ripening and labor was that described by Embrey and Mollison in 1967, and modified by Atad and colleagues in 1991. However, Barnes first described the use of these balloons a hundred years sooner in April 1861, in Obstetrical Transacricus Volume III. Barnes used a rubber balloon, filled with water; and he described that it worked rather quickly the induction-to-delivery interval was 3-4 h, which is impressive compared with 6-24 h reported with the devices of the 20th century. Corner noted: "I may briefly mention what struck me particularly in the use of these instruments: the ease with which they were introduced within the os . . . the absence of complaint on the part of the patient; and their speedy action in dilating the parts and inducing natural expulsive pains". Even today some will use a foley balloon (the same that is used to drain a woman's bladder at the time of her c-section) and use it inside of the uterus. Even more fascinating is comparison of the hypothesis of Barnes' time with that of today on how the balloon exerts its effect. At the beginning of the 20th century, the mechanism of induction of labor was thought not to be purely by mechanical dilation of cervix: force the cervix with a device or a foreign-body effect on the cervix, and then that mechanical action was also considered to simulate uterine contraction. So in 1865 Wilson tried to put tents, and Kehrer put a tampon like device in the cervix in 1888 as their version of an improvement on the bags. Modern belief holds that the basic mechanism of cervical ripening by balloon seems to be direct pressure and overstretching of the lower uterine segment and cervix, and that overstretching results in increased prostaglandin concentrations in the amniotic fluid as well as the blood stream of the mother then it's the release, the prostaglandins are involved in cervical softening and subsequent uterine contractions.
(Balloon Ripening of the Cervix; Lancet; February 1997).


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