Outpatient Cervical Ripening

McDonagh, Marian; Skelly, Andrea C.; Tilden, Ellen L.; Brodt, Erika D.; Dana, Tracy; Hart, Erica; Kantner, Shelby; Fu, Rongwei; Hermesch, Amy

doi:10.1097/aog.0000000000004382

Cited by 20 publications

(23 citation statements)

References 53 publications

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“…The authors concluded that there are currently limited data available to compare the efficacy and safety of outpatient versus inpatient induction, making it difficult to draw any definite conclusions 47 . The latest review and meta‐analysis published in March 2021 including 30 RCTs and 10 cohort studies, including 9618 women, came to the same result: no increase in cesarean section rate in a low‐risk population in a high‐income setting, but low or insufficient evidence for the safety aspect 49 . A previous Cochrane review evaluating the effects of outpatient induction on maternal and fetal/neonatal outcomes, including 1439 women, came to the same conclusion 8 .…”

Section: Discussionmentioning

confidence: 99%

Safety, effectiveness, womenʼs experience, and economic costs of outpatient induction in women with uncomplicated pregnancies: A systematic review and meta‐analyses

Sangskär

Berglin

Sengpiel

et al. 2023

Intl J Gynecology & Obste

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Background Induction of labor is increasing worldwide, and some countries have started to introduce outpatient induction in low‐risk women. Objectives To assess current knowledge concerning the safety, efficacy, women's experience, and economic costs of outpatient induction compared with inpatient induction. Search strategy Multiple databases were last searched on October 19, 2021. Studies were selected according to our pre‐specified inclusion, selection, and exclusion criteria. Selection criteria PICO; P—women with low‐risk pregnancy planned for induction of labor. I—Outpatient induction C—Inpatient induction O—Outcomes according to the core outcome set for induction of labor (COSIOL). Data collection and analysis Pooled in meta‐analyses. The certainty of evidence was assessed using the GRADE system. Main results The 20 included studies, including 7956 women, showed an overall low incidence of adverse events and indicated comparable results for inpatient and outpatient induction, but the studies were underpowered for safety‐related outcomes. Women's experiences of outpatient induction were mostly positive. Based on three studies, the economic costs consequence is inconclusive. Conclusions Due to early randomization, heterogenic study design, and underpowered studies regarding safety outcome, the certainty of evidence is very low. It is uncertain whether outpatient induction affects the risk for neonatal and maternal complications.

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Section: Discussionmentioning

confidence: 99%

Safety, effectiveness, womenʼs experience, and economic costs of outpatient induction in women with uncomplicated pregnancies: A systematic review and meta‐analyses

Sangskär

Berglin

Sengpiel

et al. 2023

Intl J Gynecology & Obste

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“…With an increasing number of labor inductions, interest in performing cervical ripening and IOL in an outpatient setting has increased 1,2,8,9 . IOL, especially for primiparas with an unfavorable cervix, can take a substantial amount of time, ranging from hours to days.…”

Section: Introductionmentioning

confidence: 99%

“…Undergoing cervical ripening at home is an attractive option to reduce potentially the duration of antenatal hospital stay, reduce strain on healthcare resources, increase satisfaction and comfort for patients, and to reduce financial costs 8,10–15 . Currently, there is limited evidence for IOL with oral misoprostol in an outpatient setting 2,6,9,14 …”

Section: Introductionmentioning

confidence: 99%

“…With an increasing number of labor inductions, interest in performing cervical ripening and IOL in an outpatient setting has increased. 1 , 2 , 8 , 9 IOL, especially for primiparas with an unfavorable cervix, can take a substantial amount of time, ranging from hours to days. Undergoing cervical ripening at home is an attractive option to reduce potentially the duration of antenatal hospital stay, reduce strain on healthcare resources, increase satisfaction and comfort for patients, and to reduce financial costs.…”

Section: Introductionmentioning

confidence: 99%

“… 8 , 10 , 11 , 12 , 13 , 14 , 15 Currently, there is limited evidence for IOL with oral misoprostol in an outpatient setting. 2 , 6 , 9 , 14 …”

Section: Introductionmentioning

confidence: 99%

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

Hallén

Amini

Wide‐Swensson

et al. 2023

Acta Obstet Gynecol Scand

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Introduction: Induction of labor is one of the most common obstetrical procedures today, with a successively rising rate. With a limited number of hospital beds, the option of starting induction at home has gained increasing attention. The primary aim of this study was to compare the proportion of women achieving vaginal delivery and the duration of hospital stay before delivery in induction of labor with oral misoprostol starting at home and induction with oral misoprostol at the hospital, in a low-risk population.Material and methods: Women with home induction (n = 282) were individually matched to controls induced at the hospital during the same time period regarding parity, age, body mass index, labor unit and indication for induction. Results:The rates of vaginal birth were similar in outpatients and inpatients (84.8% vs 86.2%; p = 0.5). Time from hospital admission to delivery in the outpatient group was significantly shorter than in the inpatient group (12.8 vs 20.6 h; p < 0.001), as was total hospital stay (2 vs 3 days; p < 0.001). There were no significant differences between the groups in neonatal or maternal outcomes. One patient undergoing outpatient induction had an unplanned home birth. Conclusions:Starting induction at home reduced the time spent in hospital without affecting the vaginal delivery rate. Although underpowered to assess safety, this study did not show any differences in adverse maternal and perinatal outcomes between inpatients and outpatients. Further research is needed to evaluate the safety of outpatient induction of labor with misoprostol.

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Analysis of Obstetric Outcomes by Hospital Location, Volume, and Teaching Status Associated With Non–Medically Indicated Induction of Labor at 39 Weeks

et al. 2023

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ImportanceNon–medically indicated induction of labor has been demonstrated to potentially improve some obstetric outcomes, such as decreasing cesarean birth. It has been reported that rates of cesarean birth and other obstetric outcomes vary among hospitals with different characteristics.ObjectiveTo assess whether obstetric outcomes differ between nulliparous individuals with low-risk pregnancies managed with non–medically indicated induction of labor compared with expectant management in different types of hospitals.Design, Setting, and ParticipantsThis retrospective cohort study included non–medically indicated induction of labor at 39 weeks' gestation compared with expectant management of singleton, nonanomalous, births in nulliparous women with low-risk pregnancies in California between January 1, 2007, and December 31, 2011. The initial analysis of these data was performed in 2021. Outcomes were assessed by 3 hospital characteristics: location (urban vs rural), obstetric volume, and teaching (academic vs community) status. Volume was categorized based on the average number of births per year and grouped into low (&lt;1200 births per year), medium (1200-2399 births per year), and high (≥2400 births per year). Births with previous or planned cesarean delivery were excluded, and non–medically indicated induction of labor was defined as induction of labor without a specific medical indication. Testing with χ2 and multivariable logistic regression analyses was used for statistical comparisons with a cutoff level of P = .01.ExposureNon–medically indicated induction of labor at 39 weeks’ gestation.Main Outcomes and MeasuresThe primary outcome was cesarean birth, and numerous secondary perinatal outcomes were also assessed.ResultsThere were 455 044 births included in this study. When stratified by hospital variables, a number of sociodemographic characteristics were significantly different, such as race and ethnicity, age, body mass index, and insurance type. The adjusted odds ratios (aORs) of cesarean birth were significantly lower in all settings with induction of labor except for low-volume hospitals, in which there was no significant difference (aOR, 0.95; 95% CI, 0.82-1.09). Chorioamnionitis and postpartum hemorrhage were lower with induction of labor among nearly every hospital when stratified by hospital characteristics. Neonatal outcomes were improved in all settings with induction of labor compared with expectant management.Conclusions and RelevanceThese findings suggest that non–medically indicated induction of labor may be associated with a lower rate of cesarean births and some maternal and neonatal adverse outcomes in a range of hospital settings.

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Outpatient Cervical Ripening

Abstract: E, et al. Outpatient cervical ripening: a systematic review and meta-analysis. Obstet Gynecol 2021;137. The authors provided this information as a supplement to their article.

Cited by 20 publications

References 53 publications

Safety, effectiveness, womenʼs experience, and economic costs of outpatient induction in women with uncomplicated pregnancies: A systematic review and meta‐analyses

Safety, effectiveness, womenʼs experience, and economic costs of outpatient induction in women with uncomplicated pregnancies: A systematic review and meta‐analyses

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

Analysis of Obstetric Outcomes by Hospital Location, Volume, and Teaching Status Associated With Non–Medically Indicated Induction of Labor at 39 Weeks

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