Grand Rounds

The FIAT-M study: Simultaneous or Sequential Foley and Oxytocin for Induction in Multiparous Women

BACKGROUND AND PURPOSE:

Connolly et. al. (American Journal of Perinatology, 2017) studied whether the simultaneous or sequential use of Foley balloon and oxytocin was more efficient in inducing labor

A randomized controlled trial (RCT) of 142 multiparous women who presented for induction
Inclusion criteria
- Nonanomalous, singleton fetus ≥ 24 weeks in vertex presentation with intact membranes
Exclusion criteria
- History of uterine surgery, unexplained vaginal bleeding, latex allergy, or contraindication to vaginal delivery
Subjects were categorized as:
- Simultaneous (oxytocin started within 1 hour of Foley balloon)
- Sequential (oxytocin to start following expulsion of Foley)
  - If spontaneous expulsion did not occur, the Foley balloon was removed after 12 hours of cervical ripening
Primary outcome
- Time from induction to delivery
Secondary outcomes
- Mode of delivery, estimated blood loss (EBL), postpartum hemorrhage (PPH), chorioamnionitis, and composite neonatal outcome

When comparing simultaneous to sequential

No difference in the baseline characteristics of the two groups
No difference in time to delivery
- 10.7 vs 10.6 hours (P=0.44)
- Not affected by Bishop score < 2
No difference in rate of cesarean delivery
- 7% vs 12% (P=0.28)
No difference in EBL, PPH, chorioamnionitis, or composite neonatal outcome

Authors acknowledge limitations of the study which included
- lack of blinding
- Setting of tertiary care center may limit generalizability
- Use of 60 cc to fill Foley bulb and more rapid increase of oxytocin may not be the same protocol used in other centers
Simultaneous use of oxytocin and Foley balloon for induction does not decrease time to delivery in multiparas which differs from their finding in nulliparous women in a previous study
Both groups had low cesarean section rates

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