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Background The optimal method of labor induction is not known. It is important to determine the safest and efficient method to minimize the length of labor, hospital stay, cost, and adverse outcomes. Objective This study aims to determine if induction of labor with simultaneous use of oxytocin and Foley balloon versus the sequential use of Foley balloon followed by oxytocin decreases the time to delivery in multiparous women. Study Design We conducted a randomized controlled trial of multiparous women who presented for induction of labor at Mount Sinai from December 2013 to April 2016. Patients were admitted for induction with indications determined by their provider. Women with a nonanomalous, singleton fetus ≥ 24 weeks in vertex presentation with intact membranes were offered participation. Exclusion criteria included the history of uterine surgery, unexplained vaginal bleeding, latex allergy, or contraindication to vaginal delivery. Participants were randomized to either simultaneous (oxytocin and Foley balloon) or sequential (oxytocin after the expulsion of Foley balloon) induction group. The primary outcome was the time from induction to delivery. Secondary outcomes included mode of delivery, estimated blood loss (EBL), postpartum hemorrhage (PPH), chorioamnionitis, and composite neonatal outcome. Maternal and neonatal outcomes were collected via chart review. Analyses were done on an intention-to-treat basis. Results A total of 142 patients were enrolled; 75 in the simultaneous and 67 in the sequential group. There were no differences in baseline characteristics in the two groups. There was no difference in median time to delivery between groups (10.7 vs. 10.6 hours, p = 0.44). There was no difference in the rate of cesarean delivery, EBL, PPH, chorioamnionitis, or composite neonatal outcome. Conclusion Simultaneous use of oxytocin and Foley balloon for induction of labor does not decrease time to delivery in multiparas.

Preterm premature rupture of the membranes (PPROM) is spontaneous rupture of membranes before 37 weeks' gestation before the onset of labor. The standard of care is inpatient management with antibiotics and monitoring. Bed rest has not been shown to be beneficial in the setting of PPROM and has adverse maternal effects. We conducted a pilot randomized clinical trial (RCT) to determine the feasibility of recruitment for an RCT of this nature and obtain estimates of the frequency of maternal and neonatal outcomes.Patients who were diagnosed with PPROM 34 weeks gestational age were randomized to bed rest versus activity in a 1:1 ratio. Subjects in both groups wore pedometers and kept activity logs. Maternal demographic and obstetric data and neonatal outcomes were collected and compared between groups using chi-square and Fisher exact tests. Latency was evaluated with log-rank test and Kaplan-Meier analysis.In this study, 36 women were enrolled and randomized; 1 patient withdrew. Complete data were available for 21 subjects. In univariable analysis, women in the activity group had a nonsignificantly shorter latency time than the bed rest group (median 6.0 vs. 8.5 days). Neonatal outcomes were similar between groups. Using log-rank sum analysis, neonates born to mothers in the activity group were more likely to develop necrotizing enterocolitis (NEC) than in the control group (24 vs. 0%, p = 0.05); this difference was not significant after false discovery rate correction (p = 0.80).This is the first randomized controlled study to evaluate bed rest versus normal activity in the setting of PPROM 34 weeks. This study demonstrates a nonsignificant increase in latency to delivery on bed rest and possible increase in NEC in the activity group; the mechanism remains unclear. We would recommend a larger RCT to better clarify these findings.