Labor Induction Outcomes with Outpatient Misoprostol for Cervical Ripening among Low-Risk Women

Abstract

Objective: In 2012, two Kaiser Permanente Northern California hospitals began offering outpatient cervical ripening with oral misoprostol under a study protocol. We evaluated inpatient time from admission to delivery and adverse maternal and neonatal outcomes associated with outpatient use of misoprostol for cervical ripening among low-risk women with term pregnancies. Study Design: We conducted a retrospective cohort study of 345 women who received misoprostol outpatient vs. inpatient at the study sites (n=1,374) and at all Kaiser hospitals (n=9,908) between 2012 and 2017. Results: Women in the outpatient group were more likely to be White than both inpatient groups (63.3% vs. 56.3% at study sites and 47.1% all hospitals, P=.002 and <.001); other demographics were clinically comparable. Most women undergoing labor induction were nulliparous; however, a greater proportion in the outpatient group were nulliparous compared to inpatient groups (70.8% vs. 61.8% and 64.3%, P=.002 and .01). Prior to the administration of misoprostol, women in the outpatient misoprostol group were more likely to present with no cervical dilation (34.7% vs. 34.9% and 34.9%, P=.10 and >.999). On inpatient admission, women who received outpatient misoprostol were more likely to have a cervical dilation of ≥3 cm (39.8% vs. 12.5% and 9.7%, P<.001). The outpatient group had a shorter mean time between admission and delivery (23.6 vs. 29.4 and 29.8 hours, P<.001). The adjusted estimated mean difference between the outpatient and inpatient groups in time from admission to delivery was -6.48 hours (P<.001), and the adjusted estimated mean difference in cervical dilation on admission was +1.02 cm (P<.001). There was no difference in cesarean delivery rates between groups. Conclusion: Outpatient use of misoprostol for cervical ripening is associated with reduced inpatient time from admission to delivery compared to inpatient misoprostol, and had no difference in rates of cesarean delivery or maternal or neonatal complications.

Outpatient vs inpatient induction of labor with oral misoprostol: A retrospective study

“…Our results are consistent with two available studies using single doses of misoprostol for outpatient cervical ripening. Kandahari et al conducted a retrospective cohort study of 345 women undergoing cervical ripening as an outpatient regimen 17 . Roloff et al conducted a retrospective cohort study comparing 56 women induced as outpatients with matching controls induced as inpatients 18 .…”

“…Kandahari et al conducted a retrospective cohort study of 345 women undergoing cervical ripening as an outpatient regimen. 17 Roloff et al conducted a retrospective cohort study comparing 56 women induced as outpatients with matching controls induced as inpatients. 18 Both studies showed shorter time from admission to delivery with outpatient start of induction and no significant differences in delivery outcomes compared with an inpatient group.…”