Induction of labor with an unfavorable cervix

Abstract

ObjectiveTo compare three techniques to induce labor in nulliparous women with unfavorable cervices.Study designAn RCT of 281 nulliparous women at term, comparing PGE2, single balloon catheter, and double balloon catheter for induction of labor with modified Bishop scores of 0 to 4 after stratification based on fetal fibronectin status.ResultsThere were no significant differences in baseline data between groups. Outcome data are presented as percentages and medians with interquartile ranges (see Table). Fetal fibronectin status did not predict mode of delivery (NS). There were no differences in maternal satisfaction (P = 0.282) or rates of postnatal complications among the three groups; however, the umbilical arterial blood gas results were significantly worse in the PGE2 group than in the balloon groups (P<0.05).ConclusionOf the three techniques, PGE2 is associated with the highest rate of fetal compromise. The single balloon catheter has the most favorable combination of success, safety, and cost for women with Bishop scores of 0 to 4. Tabled 1PGE2 (n = 94)Single Balloon (n = 94)Double Balloon (n = 93)P valueCesarean section (CS) total36%36%41%0.747CS: Failed induction4%11%10%0.040CS: Fetal distress19%13%13%0.161Hyperstimulation11%0%0%<0.001Requiring scalp pH27%13%15%0.031Delivered due to scalp pH10%3%1%0.015Induction-delivery (hrs)21.4 (14.2, 20.9)19.1 (5.5, 33.5)22.5 (15, 23.1)0.068Cost$103$1.40$81 Open table in a new tab ObjectiveTo compare three techniques to induce labor in nulliparous women with unfavorable cervices. To compare three techniques to induce labor in nulliparous women with unfavorable cervices. Study designAn RCT of 281 nulliparous women at term, comparing PGE2, single balloon catheter, and double balloon catheter for induction of labor with modified Bishop scores of 0 to 4 after stratification based on fetal fibronectin status. An RCT of 281 nulliparous women at term, comparing PGE2, single balloon catheter, and double balloon catheter for induction of labor with modified Bishop scores of 0 to 4 after stratification based on fetal fibronectin status. ResultsThere were no significant differences in baseline data between groups. Outcome data are presented as percentages and medians with interquartile ranges (see Table). Fetal fibronectin status did not predict mode of delivery (NS). There were no differences in maternal satisfaction (P = 0.282) or rates of postnatal complications among the three groups; however, the umbilical arterial blood gas results were significantly worse in the PGE2 group than in the balloon groups (P<0.05). There were no significant differences in baseline data between groups. Outcome data are presented as percentages and medians with interquartile ranges (see Table). Fetal fibronectin status did not predict mode of delivery (NS). There were no differences in maternal satisfaction (P = 0.282) or rates of postnatal complications among the three groups; however, the umbilical arterial blood gas results were significantly worse in the PGE2 group than in the balloon groups (P<0.05). ConclusionOf the three techniques, PGE2 is associated with the highest rate of fetal compromise. The single balloon catheter has the most favorable combination of success, safety, and cost for women with Bishop scores of 0 to 4. Tabled 1PGE2 (n = 94)Single Balloon (n = 94)Double Balloon (n = 93)P valueCesarean section (CS) total36%36%41%0.747CS: Failed induction4%11%10%0.040CS: Fetal distress19%13%13%0.161Hyperstimulation11%0%0%<0.001Requiring scalp pH27%13%15%0.031Delivered due to scalp pH10%3%1%0.015Induction-delivery (hrs)21.4 (14.2, 20.9)19.1 (5.5, 33.5)22.5 (15, 23.1)0.068Cost$103$1.40$81 Open table in a new tab Of the three techniques, PGE2 is associated with the highest rate of fetal compromise. The single balloon catheter has the most favorable combination of success, safety, and cost for women with Bishop scores of 0 to 4. Tabled 1PGE2 (n = 94)Single Balloon (n = 94)Double Balloon (n = 93)P valueCesarean section (CS) total36%36%41%0.747CS: Failed induction4%11%10%0.040CS: Fetal distress19%13%13%0.161Hyperstimulation11%0%0%<0.001Requiring scalp pH27%13%15%0.031Delivered due to scalp pH10%3%1%0.015Induction-delivery (hrs)21.4 (14.2, 20.9)19.1 (5.5, 33.5)22.5 (15, 23.1)0.068Cost$103$1.40$81 Open table in a new tab