Saturday, September 15, 2018

What is the best approach for labor induction in a multiparous patient?


Simultaneous administration of oxytocin along with cervical ripening with balloon catheter minimized the time to vaginal delivery and increased the rate of delivery within 24 hours in multiparous patients with an unfavorable cervix. This has significant benefits regarding patient care and satisfaction reports the results of a randomized control trial published in September issue of the American Journal of Obstetrics and Gynecology.

The best method of induction of labor in a multiparous patient is debatable because of a paucity of data. Results available from the only previous RCT comparing the simultaneous vs. sequential use of balloon catheter and oxytocin found no difference in median time to delivery between the two groups (FIAT-M Trial).

In this RCT involving 180 patients, Bauer et al. sought to determine whether the simultaneous vs. sequential use of balloon catheter and oxytocin helps decrease the time to delivery in multiparous patients who present with an unfavorable cervix.

The study recruited multiparous women ≥18 years with prior vaginal delivery who needed induction of labor and presented with a non-anomalous, singleton fetus in cephalic presentation with intact membranes with cervical dilatation ≤2 cm on admission.

Women were randomized to receive either simultaneous (oxytocin with cervical ripening balloon) or sequential (oxytocin following cervical ripening balloon expulsion) regimen.

Investigators looked at the time from induction to delivery as the primary outcome measure while the secondary measures of interest were time to cervical ripening balloon expulsion, induction-to-delivery interval, mode of delivery and adverse maternal or neonatal outcomes.

Women who simultaneously received balloon and oxytocin were more likely to deliver within 24 hours as compared to those in whom oxytocin was started after the balloon expulsion (87.8% vs. 73.3%; P=0.02). The average induction-to-delivery interval in the simultaneous group was 12.5 h vs. 16.3 h with greater cervical dilatation when the balloon was expelled.

Both groups were comparable regarding mode of delivery, chorioamnionitis, or adverse maternal or neonatal outcomes.

The authors concluded that “The simultaneous use of oxytocin with cervical ripening balloon should be incorporated into the management for multiparous women who require cervical ripening while undergoing induction of labor.”

Presented as a poster at the 38th Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, Jan. 29–Feb. 3, 2018.

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