Combination Labor Induction Method Shortens Delivery Time

A combination of mechanical and pharmacologic labor induction leads to delivery several hours earlier than either method alone, claims a new study.

Researchers at the University of Pennsylvania (PA, USA) conducted a randomized trial to compare four labor induction methods: misoprostol (a prostaglandin-like drug) alone, cervical Foley catheter alone, concurrent use of misoprostol and a cervical Foley catheter, and concurrent use of a Foley catheter and the contraction-inducing hormone oxytocin. In all, from May 2013 to June 2015, 491 women undergoing labor induction with full-term singleton, vertex-presenting gestations, and no contraindication to vaginal delivery participated, with the primary outcome being time to delivery.

The results showed the average time between treatment and delivery was lowest for the misoprostol-Foley combination at 13.1 hours, compared to 14.5 hours for Foley-oxytocin, 17.6 hours for misoprostol alone, and 17.7 hours for the Foley method alone. According to the researchers, the more than four-hour gap between misoprostol-Foley and either method alone is clinically meaningful, particularly considering that the various methods did not produce significant differences in the rates of cesarean deliveries or of serious medical complications for the mother or child. The study was published in the December 2016 issue of Obstetrics & Gynecology.

"Using combination methods in every case of labor induction in America would spare pregnant women more than 100,000 days of labor annually,” said lead author Lisa Levine, MD. “That in turn would reduce hospital costs, reduce the health risks to mother and child that come with prolonged labor, and reduce the stress that mothers experience while awaiting delivery.”

Labor induction is one of the most common medical procedures in the world, with nearly one million women who deliver in the United States alone undergoing the procedure annually. But despite its widespread use, including for medical conditions such as preeclampsia, gestational diabetes, or other health risks to the mother or baby, labor induction is still costly and has no widely accepted best practice guideline.

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