What is the Best Labor Induction Method for Multiparous Women?
BACKGROUND AND PURPOSE:
Ripening is indicated if a cervix is unfavorable
Foley balloon (mechanical ripening) is a commonly used approach, as well as the addition of pharmacologic agents
Data is limited on the best approach in multiparous women with only one previous RCT (see ‘Related ObG Topics’ below: FIAT-M study)
Bauer et al. (AJOG 2018) sought to determine the best induction method for for multiparous women with an unfavorable cervix
Randomized controlled trial (RCT)
Participants: Multiparous women, ≥18 years with prior vaginal delivery
Singleton nonanomalous fetus | ≥34 weeks | Vertex presentation | EFW <4500 g | cervical dilation ≤2 cm on admission to labor and delivery
>1 prior cesarean or complicated delivery, particularly if a contraindication to vaginal delivery were excluded
Women were randomized into the following groups
Simultaneous (oxytocin with cervical ripening balloon)
Sequential (oxytocin following cervical ripening balloon expulsion)
Primary outcome: Delivery within 24 hours of cervical ripening balloon placement
Induction-to-delivery interval | Time to cervical ripening balloon expulsion | Mode of delivery | Adverse maternal or neonatal outcomes
180 patients were included
Baseline demographic and obstetric characteristics were similar between groups
When compared to the sequential group, women in the simultaneous group
Were more likely to deliver within 24 hours vs the sequential group (87.8% vs 73.3%; P=0.02)
Had a shorter induction-to-delivery interval (12.5 h vs 16.3 h; P=0.01)
Had greater cervical dilation at cervical ripening balloon expulsion (4 cm vs 3.5 cm; P=0.001)
There were no differences in mode of delivery, chorioamnionitis, or adverse maternal or neonatal outcomes
Simultaneous administration of oxytocin and cervical ripening balloon lead to a greater success for induced labor compared to sequential administration
Authors note that they used all delivery within 24 hours, rather than vaginal delivery
Vaginal delivery was not itself statistically significant but time to vaginal delivery was improved in the simultaneous group
The authors recommend 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.”
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan