Cervical ripening as an outpatient procedure in the pandemic – minimizing the inpatient days and lowering the socioeconomic costs

Abstract

Objectives With an increasing incidence of labor induction the socioeconomic costs are increasing and the burden on hospital capacities is rising. In addition, the worldwide SARS-CoV-2 pandemic asks for improvements in patient care during pregnancy and delivery while decreasing the patient-staff contact. Here, we are retrospectively analyzing and comparing a mechanical ripening device that is utilized as an outpatient procedure to misoprostol and dinoprostone as inpatient induction methods in a low risk cohort. Methods This is a retrospective comparative analysis of obstetric data on patients who presented for cervical ripening and labor induction. Ninety-six patients received a mechanical ripening agent as an outpatient procedure. As a control group, we used 99 patients with oral misoprostol (PGE1) and 42 patients with vaginal dinoprostone (PGE2) for cervical ripening in an inpatient setting. Data from 2016 until 2020 were analysed. Results Baseline characteristics showed no significant differences. Delivery modes were similar in all groups. The time period from patient admission to onset of labor was significantly shorter in the outpatient group (p<0.001): 10.9 h/0.5 days (±13.6/0.6) for osmotic dilator vs. 17.9 h/0.7 days (±13.1/0.5) for oral misoprostol vs. 21.8 h/0.8 days (±15.9/0.7) for vaginal dinoprostone. With 20.4 h/0.8 days (±14.3/0.6) the osmotic dilator group displayed significantly the shortest inpatient stay from admission to delivery (p=0.027). The patient subgroup of misoprostol had 25.7 h/1.1 days (±14.9/0.6) of inpatient stay from admission to delivery and the patient group of dinoprostone 27.5 h/1.1 days (±16.0/0.7). There were fewer hospital days in the outpatient group: 84.9 h/3.5 days vs. 88.9 h/3.7 days vs. 93.6 h/3.9 days (outpatient osmotic dilator vs. inpatient misoprostol and dinoprostone, respectively). Conclusions New approaches are required to decrease individual contacts between patients and staff while maintaining a high quality patient care in obstetrics. This analysis reveals that outpatient mechanical cervical ripening can be as safe and effective as inpatient cervical ripening with PGE1/PGE2, while lowering patient-staff contact and total hospital stays and therefore decreasing the socioeconomic costs.

Synthetic Osmotic Dilators for Pre-Induction Cervical Ripening – an Evidence-Based Review

“…A retrospective analysis comparing cervical ripening with Dilapan-S in an outpatient procedure with the use of oral misoprostol or vaginal PGE 2 gel in an inpatient setting has shown that cervical ripening with Dilapan-S resulted in a significant reduction of time period from patient admission to the onset of labor, shorter inpatient stay from admission to delivery and fewer hospital days in the outpatient group thus decreasing socioeconomic costs 37 .…”

Synthetische osmotische Dilatatoren zur Zervixreifung vor Geburtseinleitung

“…Die ambulante Anwendung osmotischer Dilatatoren war im Vergleich zur stationären Anwendung mit kürzeren stationären Krankenhausaufenthalten und schnellerem Einsetzen aktiver Wehen verbunden, ohne dass es zu signifikanten negativen Vorkommnissen kam 21 . Sie war im Vergleich zur stationären Anwendung von PGE 2 -Vaginalinserts oder Ballonkathetern mit geringeren 22 oder gleichen Kosten und geringerer Arbeitsbelastung 23 verbunden und zeigte in einem retrospektiven Vergleich mit der stationären Anwendung von Misoprostol oder PGE 2 -Vaginalgel ein schnelleres Einsetzen aktiver Wehen und kürzere Krankenhausaufenthalte bis zur Geburt 24 .…”

“…Ballonkathetern mit geringeren[22] oder gleichen Kosten und geringerer Arbeitsbelastung[23] verbunden und zeigte in einem retrospektiven Vergleich mit der stationären Anwendung von Misoprostol oder PGE 2 -Vaginalgel ein schnelleres Einsetzen aktiver Wehen und kürzere Krankenhausaufenthalte bis zur Geburt[24]. Ballonkatheter, dem 10mg-PGE2 -Vaginalinsert oder der oralen Gabe von Misoprostol.…”