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Shorter time to delivery with concurrent balloon cervical ripening and oxytocin in multiparas
Clinical Question
For multiparas with an unfavorable cervix does balloon ripening concurrent with oxytocin administration result in shorter induction time than sequential use?
Bottom line
For multiparous women who require cervical ripening for induction of labor, the concurrent use of a 35-mL Foley catheter balloon and oxytocin (compared with sequential use) resulted in reduced time to delivery by a mean of 3.8 hours and improved the rate of delivery within 24 hours by 14 percentage points. There were no significant ill effects observed for mothers or babies, though the study was not powered to assess rare adverse outcomes. 1b-
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Self-funded or unfunded
Setting: Inpatient (any location)
Synopsis
The authors enrolled 180 multiparous women to compare concurrent use and sequential use of Foley balloon cervical ripening and oxytocin administration. Adult women were included if they had a singleton, nonanomalous fetus in vertex presentation with an estimated fetal weight of less than 4500 g, a prior spontaneous vaginal delivery, and cervical dilatation not more than 2 cm on admission to labor and delivery. Women were excluded if they had ruptured membranes, infectious morbidity, more than one prior cesarean delivery, low lying placenta, or other contraindications to induction of labor with the methods used for the study. A 16F latex Foley catheter was inserted into the cervix for both groups at the beginning of the induction, and inflated with 35 mL normal saline solution. It was taped to the patient's leg at tension and left in place until spontaneous expulsion or 12 hours maximum duration. Both groups also received oxytocin infusion starting at 2 mU/min and increased by 2 mU/min every 30 minutes to a maximum of 30 mU/min with adjustments to achieve an acceptable contraction pattern. In the experimental group both modalities were used simultaneously, and in the control group oxytocin was initiated after the balloon catheter was out. Simultaneous use resulted in a mean time to delivery that was 3.8 hours shorter (16.9 vs 13.1; P = .004). The proportion of women delivering within 24 hours was also higher with concurrent modalities, 88% vs 73% (P = .023; number needed to treat = 7; 95% CI 4 - 35). There were no significant differences in maternal or neonatal morbidities, though the study was not large enough to evaluate rare adverse events. Cesarean delivery for nonreassuring fetal heart tracing trended in favor of simultaneous methods (5/90 [5.6%] vs 13/90 [14.4%]; P = .08).
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Comments
Good poem
While I don;t do FP OB anymore, this is an interesting study. Always wondered about this scenario. I also wonder if they looked at the timing of the start of the induction.