283: Two center RCT of outpatient versus inpatient cervical ripening for induction of labour with PGE2

Wilkinson, Chris; Bryce, Robert L.; Adelson, Pamela; Coffey, Judy; Coomblas, John; Ryan, Philip; Stamp, Georgina E.; Turnbull, Deborah

doi:10.1016/j.ajog.2011.10.301

Cited by 5 publications

(3 citation statements)

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“…Accordingly, catheter was chosen as our outpatient arm due to meta-analysis reporting lower rates of hyperstimulation than with Prostin [3], women in the OPC arm were not discharged unless post-insertion CTG was reassuring, and OPC women were advised to represent promptly if contracting regularly, membranes ruptured or they had any concerns. As expected hyperstimulation was not seen in the OPC group, however four OPC women (8%) remained inpatients due to CTG concerns post-insertion, compared to 13% of the outpatient arm in a recent report of outpatient vs. inpatient PGE2 [12]. One woman had a pathological trace at Birthing Unit admission after erroneously being told to remain at home when she called to report regular contractions.…”

Section: Discussionmentioning

confidence: 58%

Outpatient Foley catheter versus inpatient prostaglandin E2 gel for induction of labour: a randomised trial

Henry

Madan

Reid

et al. 2013

BMC Pregnancy Childbirth

134

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BackgroundInduction of labour (IOL) is one of the commonest obstetric interventions, with significant impact on both the individual woman and health service delivery. Outpatient IOL is an attractive option to reduce these impacts. To date there is little data comparing outpatient and inpatient IOL methods, and potential safety concerns (hyperstimulation) if prostaglandins, the standard inpatient IOL medications, are used in the outpatient setting. The purpose of this study was to assess feasibility, clinical effectiveness and patient acceptability of outpatient Foley catheter (OPC) vs. inpatient vaginal PGE2 (IP) for induction of labour (IOL) at term.MethodsWomen with an unfavourable cervix requiring IOL at term (N = 101) were randomised to outpatient care using Foley catheter (OPC, n = 50) or inpatient care using vaginal PGE2 (IP, n = 51). OPC group had Foley catheter inserted and were discharged overnight following a reassuring cardiotocograph. IP group received 2 mg/1 mg vaginal PGE2 if nulliparous or 1 mg/1 mg if multiparous. Main outcome measures were inpatient stay (prior to birth, in Birthing Unit, total), mode of birth, induction to delivery interval, adverse reactions and patient satisfaction.ResultsOPC group had shorter hospital stay prior to birth (21.3 vs. 32.4 hrs, p < .001), IP were more likely to achieve vaginal birth within 12 hours of presenting to Birthing Unit (53% vs. 28%, p = .01). Vaginal birth rates (66% OPC Vs. 71% IP), total induction to delivery time (33.5 hrs vs. 31.3 hrs) and total inpatient times (96 hrs OPC Vs. 105 hrs IP) were similar. OPC group felt less pain (significant discomfort 26% Vs 58%, p = .003), and had more sleep (5.8 Vs 3.4 hours, p < .001), during cervical preparation, but were more likely to require oxytocin IOL (88 Vs 59%, p = .001).ConclusionsOPC was feasible and acceptable for IOL of women with an unfavourable cervix at term compared to IP, however did not show a statistically significant reduction in total inpatient stay and was associated with increased oxytocin IOL.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN:12609000420246.

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Section: Discussionmentioning

confidence: 58%

Outpatient Foley catheter versus inpatient prostaglandin E2 gel for induction of labour: a randomised trial

Henry

Madan

Reid

et al. 2013

BMC Pregnancy Childbirth

134

View full text Add to dashboard Cite

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“…We changed the reporting of Wilkinson 2015 -OPRA (Wilkinson 2012 in previous version of review, Kelly 2013) from 'per protocol' to 'intention-to-treat analysis'.…”

Section: Dealing With Missing Datamentioning

confidence: 99%

“…We changed the reporting of (Wilkinson 2012 in previous 2013 version of review) from 'per protocol' to 'intention-to-treat analysis'. With the addition of one new trial of vaginal PGE2, there is now no evidence of a difference between the likelihood of women requiring instrumental delivery in either setting.…”

Section: Characteristics Of Ongoing Studies [Ordered By Study Id]mentioning

confidence: 99%