422 An RCT of sequential versus simultaneous use of foley balloon and oxytocin for labor induction

Abstract

To determine whether the induction of labor with simultaneous use of oxytocin and decreases the time to delivery in nulliparous women as compared to sequential use of Foley balloon followed by oxytocin. We conducted a randomized clinical trial of nulliparous women presenting for induction of labor at Saint Paul’s Hospital. Nulliparous women with singleton pregnancies for whom ripening of the cervix followed by induction of labor with oxytocin was decided were recruited for the study. They were randomly assigned to either simultaneous or sequential groups. In the sequential group, oxytocin was started after the Foley catheter is expelled or was put in place for 12 hours whichever comes first. While in the simultaneous group oxytocin was started within one hour of the insertion of Foley catheter and the two groups were compared. The primary outcome was the induction to delivery time. Secondary outcomes included are cesarean delivery rate, rates of chorioamnionitis, and composite neonatal score. An intention-to-treat (ITT) analyses was used. A total of 140 women were recruited and 70 women were started on simultaneous trans-cervical Foley balloon insertion with oxytocin while the rest 70 were started with sequential mode. The median (interquartile range) of the oxytocin initiation to delivery time was 6.9 (4.3, 10.7) hrs and 8.1 (4.7, 11.6) hrs for the sequential and simultaneous group respectively (P-value= 0.46). There was no difference in the induction delivery time and the rate of the cesarean section between the two groups. Contrary to the previous studies the simultaneous initiation of oxytocin didn’t show a reduction in the Oxytocin to delivery time.