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Labor Induction with Cervical Ripening Balloon and Oxytocin

Study finds simultaneous use increases chance of delivery within 24 hours among multiparous women with unfavorable cervix


Innovations in Obstetrics & Gynecology - Fall 2018

Alison Bauer, MD


Clinical Fellow, Department of Obstetrics and Gynecology, UH Cleveland Medical Center; Clinical Instructor, Case Western Reserve University School of Medicine

David Hackney, MD


Chief, Division of Maternal and Fetal Medicine, UH Cleveland Medical Center; Associate Professor, Case Western Reserve University School of Medicine

During labor, the cervix must dilate in response to uterine contractions to achieve vaginal birth. Cervical ripening balloons and oxytocin are both commonly used in the induction of labor for pregnant women to enhance the ease of cervical dilatation. While a number of studies have examined the use of cervical ripening balloons and oxytocin, they have produced conflicting results.

Alison Bauer, MD, Clinical Fellow in the Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology at University Hospitals Cleveland Medical Center, set out to study whether a cervical ripening balloon used simultaneously or sequentially with oxytocin in multiparous women with unfavorable cervixes increases the chance of vaginal delivery within 24 hours.

Dr. Bauer, who was serving her medical residency at UH Cleveland Medical Center at the time, led the randomized controlled trial. The study enrolled 180 women who had prior vaginal births, whereas many previous studies included patients without prior vaginal births.

“We wanted to study one uniform patient group,” says David Hackney, MD, Chief of Maternal and Fetal Medicine at UH Cleveland Medical Center and the faculty advisor overseeing the study.

“Our clinical suspicions were that there would be benefits to doing both treatments at the same time,” Dr. Hackney says.

The study results supported the hypothesis. They demonstrated that simultaneous use – compared with sequential use – of a cervical ripening balloon and oxytocin does increase the chances of delivery within 24 hours. The total time between the placement of the cervical ripening balloon and delivery was significantly reduced. Additionally, the study did not identify any additional risks to simultaneous use of a cervical ripening balloon and oxytocin.

The study, which was published in the American Journal of Obstetrics & Gynecology, did not demonstrate an increase in the chance of vaginal delivery or a reduction in Cesarean delivery rates.

The clinical implications of the study are clear. The simultaneous use of a cervical ripening balloon and oxytocin reduced the amount of time multiparous women spend in labor. For patients, a shorter labor period means less time spent in the hospital.

Future research could examine how a reduced labor to delivery interval affects costs. “We didn’t look at cost, specifically,” Dr. Hackney says. “But the earlier the delivery, the earlier you leave the hospital. This could keep down costs.”

While patient preference and cost could be two key benefits of the study findings, the results also have patient safety implications. Preeclampsia, a serious pregnancy complication, may require labor induction.

“If you induce labor because of preeclampsia, the amount of time it takes from induction to delivery would be clinically meaningful,” says Dr. Hackney.

Future research could explore the benefits of simultaneous use of a cervical ripening balloon and oxytocin in induced labor for women with preeclampsia.

UH Cleveland Medical Center and its physicians are committed to conducting thorough and pioneering research that leads the way to improved patient care. A medical resident was able to propose, execute and publish a successful clinical study with results significant to the OB/GYN field.

“Any successful performance of a randomized controlled trial entirely conceived of and performed within an institution is noteworthy,” Dr. Hackney says. “It is impressive that a medical resident conceived of this project.”


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Bauer AM, Lappen JR, Gecsi KS, et al. Cervical ripening balloon with and without oxytocin in multiparas: a randomized controlled trial. Am J Obstet Gynecol 2018;219:294.e1-6.