Outpatient cervical ripening in a district general hospital: a five-year retrospective cohort study

Abstract

The number of women undergoing induction of labour has risen steadily in recent years. Outpatient induction is becoming more common in the UK in response to the required increase in resources, although evidence supporting its safety is lacking. We reviewed the notes of low-risk women presenting for outpatient cervical ripening using prostaglandins over a five-year period, and compared our neonatal and maternal outcomes to local and national data. Of the 502 eligible women, 400 underwent outpatient treatment. Most women returned early, in labour. There were no foetal, neonatal or maternal deaths, and our neonatal morbidity compared favourably with local rates. Mode of delivery and major maternal complication rates were comparable to national maternity indicators. We conclude that outpatient cervical ripening following careful case selection does not appear to increase neonatal or maternal mortality or morbidity. It offers patients an alternative to traditional inpatient induction and may improve allocation of hospital resources. Impact statement We present a retrospective cohort study of neonatal and maternal outcomes in 502 women selected for outpatient cervical ripening for postmaturity at Bedford Hospital over the five-year period from 2010 to 2015. This study was conceived following a previous publication in this journal from Bedford Hospital in 2002 by Neale et al., which described the outcomes of 100 women who underwent outpatient cervical ripening. Our conclusions compare the results from the two studies. Out of our combined sample of 602 women, 491 were discharged home following administration of prostaglandins. This represents the largest sample size in the published literature on outpatient induction of labour, which was first undertaken in our unit in 1998 and is now widely practiced within the UK. Several publications, including the 2013 Cochrane review by Kelly et al. and a recent large survey of practice (Sharp et al. 2016 ) have highlighted the paucity of available data regarding the safety of this procedure as an outpatient. We therefore hope that the results of our study will be of interest to many maternity units who currently undertake or are considering to provide the facility for outpatient cervical ripening as a prelude to induction of labour.

The effect of maternal body mass index on duration of induced labor

“…As a result of the worldwide increasing number of women undergoing IOL and related resource and space burden at the delivery units, outpatient inductions have been adopted in some countries. As the phase of cervical ripening is relevant for outpatient as well as inpatient management, our results on time from admission to start of active labor in this national cohort is of value in spite of the related limitations . Our definition of start of active labor may limit the generalizability of the present study.…”

Foley Catheter for Outpatient Cervical Ripening: Review of the Evidence and a Proposed Model of Care

“…Outpatient cervical ripening has already been adopted in other countries outside of the United States. [4][5][6][7] Routinely, women with an unfavorable cervix undergo cervical ripening prior to an induction of labor. 2,8 Cervical ripening is often a lengthy process equating to a considerable amount of time spent in the hospital preparing the cervix for medical induction of labor.…”

Outpatient versus inpatient cervical ripening with a slow‐release dinoprostone vaginal insert in term pregnancies on maternal, neonatal, and birth outcomes: A systematic review

“…Biem et al 8 reported that women in the outpatient setting had an overall higher satisfaction rate. Evidence for women's preference in outpatient IOL is supported by the literature, and satisfaction is generally higher in the outpatient population 17,45–48 . Induction of labor may interfere with women's ability to express a personal choice or feel in control of their birth experience 44 .…”

“…Having an empowering birth experience is not necessarily about the type of labor or birth; moreover, it includes the woman's decision‐making power and her involvement in the decision‐making process 24 . Providing women with an outpatient option when requiring cervical ripening potentially improves the decision‐making process, sense of control and her overall experience with the IOL 44,47,48 …”