Induction of labor: refining strategy

  • Am Journal Obstet Gynecol

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Simultaneous use of cervical ripening balloon and oxytocin shortens time of induction of labor (IOL) in multiparous women without affecting maternal or neonatal morbidity.

Why this matters

  • 1 out of 5 pregnant women will undergo IOL in the United States.
  • IOL increases costs as a result of time spent in hospital.

Key results

  • Patients who received simultaneous cervical ripening balloon and oxytocin were more likely to deliver within 24 hours (87.8% vs 73.3%; OR, 2.61; P=.02) compared with sequential cervical ripening balloon followed by oxytocin.
  • There was no significant difference in rate of cesarean delivery, postpartum hemorrhage, chorioamnionitis, Apgar scores, or neonatal ICU admissions between groups.

Study design

  • Randomized controlled trial.
  • Women ≥34 weeks gestation, with prior spontaneous vaginal delivery, who had a plan for IOL and cervical examination ≤2 cm were included.
  • Participants were randomly assigned into 2 groups: sequential cervical ripening balloon followed by oxytocin (n=90) vs simultaneous cervical ripening balloon and oxytocin (n=90).
  • Primary outcome was delivery within 24 hours of balloon placement.
  • Funding: Study funded intramurally.

Limitations

  • Only multiparous women included.
  • Interventions could not be masked.

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