Patent Application
20080319472
Induction of labor has always been dependant on the favorability of the cervix to dilate. In order to induce labor many different medications and devices are currently utilized to bring about cervical dilation. The most widely used method is intravenous administration of oxytocin. This method is often a prolonged process, especially if the cervix is unfavorable for dilation. It also requires the patient to be on continuous fetal monitoring which limits the patient's mobility. It involves patient discomfort and can cause uterine hyperstimulation and fetal distress. Another method is the administration of cytotec to the cervix, however the results can be unpredictable. It can lead to uterine hyperstimulation and uterine rupture, which places the baby and the mother at risk for death. Another drawback is that it is difficult to remove from the cervix if hyperstimulation does occur.
Other methods used to ripen the cervix include prostaglandin gels applied to the cervix which also can take many hours to work as well as cause various unwanted side effects such as nausea, vomiting, diarrhea, dysrhythmias and uterine hypertonus. Laminara has also been used to ripen the cervix, but it is uncomfortable and unreliable, and it can also take many hours for it to ripen the cervix so that the induction may be started. Stripping the membranes is another method that is used rather frequently to initiate labor. This is done by the provider inserting a gloved finger into the cervix and sweeping the amniotic membrane away from the cervix, thus causing the release of prostaglandins. This can initiate uterine contractions and help start labor, however the patient must be 1-2 cms dilated in order for this to done.
Mechanical dilators such as the Foley catheter with a 30 ml balloon or an ATAD catheter U.S. Pat. No. 4,976,692 have been used with good success. Especially, the Foley catheter with the 30 ml balloon. This catheter is placed into the cervix and once the balloon is just past the cervix then it is inflated with 50-60 ml of sterile water or normal saline. The catheter is then pulled tight and secured to the patient's thigh, and when it falls out the patient is 4-5 cms dilated. However these catheters can be uncomfortable to have placed, due to most providers using a speculum to visualize the cervix and then they thread the catheter in with a pair or ring forceps. Also the patient usually must be at least 1-2 cms dilated in order for them to be placed. Another disadvantage is that no matter how much more water is placed in the balloon, it will only have a diameter of 4-5 cms. These catheters have also been placed and a slow infusion of saline through the catheter has been used to continuously sweep the membranes away from the cervix. Although this can be risky if the catheter tip becomes clogged because the saline can build up causing an abruption.
Thus, there is the need for a catheter that can be placed much easier, and more comfortably for the patient, but also one that is simple in its method of action, safe and one that can shorten the length of labor. This could significantly lower the number of cesarean deliveries done because of the cervix's failure to dilate.
The present invention provides an improved single balloon catheter that is intended to dilate the cervix, initiate uterine contractions, and therefore shorten labor. It is approximately 42 cm in length and 2.5 mm to 4 mm in diameter. It has a balloon on the distal end, just below the drainage outlet, that when inflated it has a disc shape with a diameter of 6 cm to 8 cm and a height of 3 cm to 4 cm. The total volume should be about 100 ml to 120 ml.
The balloon, inflation tube and catheter shaft are preferably constructed of biocompatible materials. These materials include, but are not limited to, silicone, rubber including nitrile rubber, styrene butadiene rubber, viton, or butyl rubber, silicon elastomer, Dacron-reinforced silicon material, latex, polyethylene, Mylar, or Teflon. The material for the balloon should be elastomeric in nature to allow for expansion and contraction of the balloon as it is inflated or deflated.
The catheter shaft is an elongated tube that will accommodate a flexible, removable plastic stylet. The stylet has the properties of being flexible yet resilient enough to stiffen the catheter to make insertion through the cervix easier. The catheter shaft has a drainage outlet, on the side at the distal end, which allows for drainage of amniotic fluid in case of rupture of the amniotic sac. The catheter shaft also contains a smaller inflation tube inside, that has an injection port whereas a syringe can be connected to inflate the balloon with sterile water or normal saline.
Prior to inflation of the balloon the distal end of the catheter is placed through the undilated or partially dilated (0-1 cm) cervix with the stylet in place to guide the catheter through the cervix. Once the distal end with the balloon is through the cervix and in the uterine region, a syringe is utilized to inject 100 to 120 ml of sterile water or normal saline into the balloon. As the balloon is inflated it lifts the amniotic membrane off of the cervix, therefore sweeping the membrane which causes the release of prostaglandins which initiate cervical ripening and uterine contractions. The stylet is then removed, and the catheter is pulled taut and secured with adhesive tape to the patients' thigh. This causes a downward pressure on the cervix that imitates the fetal head. The patient can then walk which would provide continual stimulation of the cervix causing uterine contractions or oxytocin can be administered intravenously with the catheter being tugged gently at regular intervals when patient ambulation is not possible. When the catheter is expelled, the patient will be 6 cm to 8 cm dilated. This invention could shorten the length of labor significantly, therefore decreasing the number of ceasarean deliveries due to failure to dilate.
The invention is herein described, by way of example only, with reference to the accompanying drawings, wherein:
The catheter as illustrated in
