Effect of a mobility-encouragement protocol during induction of labor with an extraamniotic balloon compared with routine care: a randomized controlled trial.

BACKGROUND

Induction of labor with an extraamniotic balloon is common but may be lengthy and uncomfortable. Evidence on the impact of maternal mobility during extraamniotic balloon induction is limited.

OBJECTIVE

This study aimed to assess whether a mobility-encouragement protocol using pedometers affects induction-to-delivery time, pain, and maternal satisfaction.

STUDY

DESIGN

In this prospective, single-center, randomized controlled trial conducted from February 2019 to July 2020, 189 primi- and multigravidas undergoing inpatient extraamniotic balloon induction of labor with singleton pregnancies at 36 to 42 weeks' gestation and intact membranes were randomly assigned to a mobility-encouragement protocol group (feedback group, n=92) or a routine care protocol (control group, n=97). The extraamniotic balloon was the sole method of cervical ripening; oxytocin augmentation was administered only after balloon expulsion or removal. The feedback group received digital pedometers and personalized walking encouragement at 2 time points during induction of labor, whereas the control group received standard care. The primary outcome was time from extraamniotic balloon placement to delivery. Sample size was calculated to detect a clinically meaningful 15% reduction in induction-to-delivery time with 80% power and α=0.05. Secondary outcomes included pain scores, labor satisfaction, and labor outcomes. Subanalyses were conducted to examine the effect of different levels of mobility (within the experimental group) and gravidity on primary and secondary outcomes.

RESULTS

No significant differences were found between the feedback and control groups in any of the outcomes assessed, including induction-to-delivery time, pain scores, or labor satisfaction, even after accounting for gravidity. Subanalysis of mobility levels within the feedback group revealed significantly increased extraamniotic balloon insertion-to-expulsion and extraamniotic balloon insertion-to-active labor times among participants with higher mobility levels (P=.002 and P=.008, respectively).

CONCLUSION

Encouraging walking during induction of labor with an extraamniotic balloon is feasible and well tolerated. Although overall mobility did not significantly alter time to delivery or active labor, higher levels of mobility may be associated with longer labor duration. El resumen está disponible en Español al final del artículo.