Induction of Labor
Conditions
Brief summary
The aim of this study is a comparison of induction of labor with a cervical ripening balloon left in place for one hour compared to twelve hours. The primary outcome is time to delivery. Women admitted for induction of labor will be recruited and randomized to either a cervical ripening balloon for one hour or twelve hours. the management of delivery after the extraction of the balloon will be left to the discretion of the attending physician.
Detailed description
The common IOL techniques used for pregnant women with unfavorable cervix might be specified to either mechanical induction via cervical ripening balloon (CRB) or pharmacological induction. The insertion of a CRB is believed to mechanically ripen the uterine cervix with a better safety profile than prostaglandins. The duration of the balloon placement varied considerably, and it was commonly placed for 12-24 hours. Nevertheless, recent randomized controlled studies have demonstrated favorable results following only 6 hours of CRB placement with or without additional administration of oxytocin. We believe that mechanical ripening of the cervix can be achieved even less than six hours. Our study aims to evaluate the time to delivery and pregnancy outcomes after placement of CRB of only 1 hour compared to either 6 or 12 hours. Study Protocol: 1. Women planned for induction of labor will be approached by a trained resident and will sign informed consent. 2. All participants will be randomized to either one hour or twelve hours CRB placement using a computer program randomization scheme, block size of 20, by the department research coordinator who will keep the sequential in sealed envelopes. 3. Demographic parameters will be retrieved from the computerized database of Rambam Medical Center (RMC). 4. Eligible women will undergo the usual procedure of CRB insertion using a double lumen Cook cervical ripening balloon (CCRB). The CRB will be removed approximately after an hour in the intervention group and after twelve hours in the control group. Thereafter, the women will proceed amniotomy or Pitocin use at the discretion of the labor and delivery physician
Interventions
DEVICEcervical ripening balloon for one hour
The cervical ripening balloon will be left in place for one hour and after balloon removal the induction of labor will proceed at the discretion of the attending physician at labor and delivery room
DEVICEcervical ripening balloon for twelve hours
The cervical ripening balloon will be left in place for for twelve hours and after balloon removal the induction of labor will proceed at the discretion of the attending physician at labor and delivery room
Sponsors
Rambam Health Care Campus
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This will be an open-label,1:1, randomized controlled trial.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
1. Nulliparous or multiparous gravidas 2. Gestational age ≥ 370/7 to 416/7 gestational weeks 3. Age 18-45 4. Signed informed consent
Exclusion criteria
1. Contraindications for vaginal delivery 2. Multifetal gestation 3. Rupture of membranes 4. Bishop score \> 6 5. The cervix is dilated to more than 2 cm 6. Previous caesarean delivery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| insertion to delivery time interval | From date of balloon insertion until the date of delivery, assessed up to 4 days | The time interval between balloon insertion to delivery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| to compare the time to active and second stage of labor | From date of balloon insertion until the date of delivery, assessed up to 4 days | Time to active and second stage of labor |
| to compare the rate of chorioamnionitis | From date of balloon insertion until the date of discharge, assessed up to 8 days | Rate of chorioamnionitis |
| to compare the rate of post-partum hemorrhage | From date of balloon insertion until the date of discharge, assessed up to 8 days | Rate of post-partum hemorrhage and need for blood transfusion |
| to compare the need for blood transfusion | From date of balloon insertion until the date of discharge, assessed up to 8 days | the need for blood transfusion |
| to compare the rate of anal sphincter injuries | From date of balloon insertion until the date of discharge, assessed up to 8 days | Rate of obstetric anal sphincter injuries |
| To compare the length of maternal hospital stay | From date of balloon insertion until the date of discharge, assessed up to 8 days | Length of maternal hospital stay |
| to compare the mode of delivery | From date of balloon insertion until the date of delivery, assessed up to 4 days | Mode of delivery |
| To compare the Apgar score between the groups | at the date of delivery | Apgar score - higher score means better outcome. Minimal score is 0, maximal Apgar score is 10. |
| To compare the rate of neonatal acidemia between the groups | From date of delivery until the date of neonate discharge, assessed up to 14 days | Neonatal acidemia |
| To compare the rate of admission to neonatal intensive care unit between the groups | From date of delivery until the date of neonate discharge, assessed up to 14 days | Admission to neonatal intensive care unit |
| To compare the rate of Respiratory complications between the groups | From date of delivery until the date of neonate discharge, assessed up to 14 days | Respiratory complications |
| To compare the rate of neonatal sepsis between the groups | From date of delivery until the date of neonate discharge, assessed up to 14 days | Neonatal sepsis |
| To compare the rate of birthweightbetween the groups | at the date of delivery | Birthweight in grams |
| To compare the overall satisfaction rate | From date of balloon insertion until the date of discharge, assessed up to 8 days | Overall satisfaction using the Birth satisfaction scale questionnaire with higher score means a better outcome. minimal score 30, maximal score 150. |
Contacts
Primary ContactNaphtali Justman
Outcome results
None listed