Labour induction- Planned removal of single balloon catheter and oxytocin at six hours safer
Boston, MA: Women who undergo labor induction with a single balloon catheter and oxytocin have a shorter time to delivery with planned removal at six rather than twelve hours without increasing cesarean delivery, finds a recent study. According to the study, published in the American Journal of Obstetrics and Gynecology, in clinical protocols, decreasing the time length a single balloon catheter is in place should be considered.
Induction of labor is a very common practice in the US. Previous studies have suggested a faster time to delivery for improving maternal and fetal outcomes. Sarah C. Lassey, Brigham and Women's Hospital, Boston, MA, and colleagues, therefore aimed to evaluate whether women who undergo labor induction with single balloon catheter and oxytocin have a shorter time to delivery with planned removal at six vs. twelve hours.
For the purpose, the researchers performed labor induction using combination single balloon catheter and oxytocin. The study included 177 term women, both nulliparous and multiparous, aged 18-50 years old with cephalic singleton if they were undergoing induction of labor with a Bishop score less than six and cervical dilation less than 2cm.
Women were randomized to planned removal of the single balloon catheter at six (n=89) compared with twelve hours (n=88). The primary outcome was time from catheter insertion to delivery. The researchers were powered to show a four-hour time difference with a sample size of 89 women per group (n=178). Planned sensitivity analyses were performed to account for cesarean delivery in labor.
Key findings of the study include:
- Insertion to delivery time was significantly shorter in the six-hour group (19.2 vs. 24.3 hours) and the proportion of women delivered by twenty-four hours was significantly greater in the six-hour group (67.4% vs 47.4%).
- There was no difference in Bishop score at removal or secondary maternal or neonatal outcomes.
- In a Cox Proportional Hazard model censoring for cesarean delivery, the six-hour group had a significantly shorter insertion to delivery time (HR 0.67).
"Labor induction with a single balloon catheter and oxytocin with planned removal at six rather than twelve hours, results in a shorter time from insertion to delivery without increasing cesarean delivery," wrote the authors. "Decreasing the length of time a single balloon catheter is in place should be considered in clinical protocols."
The study titled, "Six vs. Twelve Hours of Single Balloon Catheter Placement with Oxytocin Administration for Labor Induction: A Randomized Controlled Trial," is published in the American Journal of Obstetrics and Gynecology.