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.
