Bauer AM, et al. - Researchers investigated whether labor induction with simultaneous use of oxytocin and a cervical ripening balloon increases the likelihood of delivery within 24 hours in multiparous women when compared with sequential use. An increased frequency of delivery within 24 hours and a shorter induction-to-delivery interval were seen to have resulted from the simultaneous use of cervical ripening balloon and oxytocin in multiparous women with an unfavorable cervix.

Methods

• In this randomized controlled trial performed between November 2014 and June 2017, researchers included multiparous women with a vertex presenting, non-anomalous singleton gestation ≥ 34 weeks undergoing induction of labor.
• The exclusion criterion included women with admission cervical examination greater than two centimeters, ruptured membranes, chorioamnionitis or evidence of systemic infection, placental abruption, low-lying placenta, more than one prior cesarean delivery, or contraindication to vaginal delivery.
• Random allocation of patients to the following cervical ripening groups was carried out: simultaneous (oxytocin with cervical ripening balloon) or sequential (oxytocin following cervical ripening balloon expulsion).
• The primary outcome was delivery within 24 hours of cervical ripening balloon placement and secondary outcomes included induction-to-delivery interval, time to cervical ripening balloon expulsion, mode of delivery, and adverse maternal or neonatal outcomes.

Results

• A total of 180 patients were randomized (90 simultaneous, 90 sequential).
• Study groups had similar baseline demographic and obstetric characteristics.
• The likelihood to deliver within 24 hours of cervical ripening balloon placement was more in women in the simultaneous group vs the sequential group (87.8% vs 73.3%, p=0.02).
• A significantly shorter induction-to-delivery interval and greater cervical dilation at cervical ripening balloon expulsion were observed in the simultaneous group.
• No differences were found in mode of delivery, chorioamnionitis, or adverse maternal or neonatal outcomes.