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Grand Rounds

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

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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

METHODS:

  • 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

RESULTS:

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

CONCLUSION:

  • 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

Learn More – Primary Sources:

A Randomized Trial of Foley Balloon Induction of Labor Trial in Multiparas (FIAT-M) 

 

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