Outpatient cervical ripening prior to induction of labour

Neale, Edmund; Pachulski, A.; Whiterod, S.; McGuinness, E.; Gallagher, Nathaniel; Wallace, R.

doi:10.1080/0144361021000020411

Cited by 12 publications

(3 citation statements)

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“…A number of papers have set out indications for outpatient cervical ripening or induction such as post-dates pregnancy in women who are otherwise well, and where there have been no signs of fetal distress. Several outpatient induction protocols have been described in observational studies suggesting that such inductions are feasible, safe and acceptable to women (Elliott 1992; McGill 2007; Neale 2002).…”

Section: Introductionmentioning

confidence: 99%

Different methods for the induction of labour in outpatient settings

Dowswell¹,

Kelly²,

Livio³

et al. 2010

Cochrane Database of Systematic Reviews

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Background Induction of labour is carried out for a variety of indications and using a range of pharmacological, mechanical and other methods. For women at low risk, some methods of induction of labour may be suitable for use in outpatient settings. Objectives To examine pharmacological and mechanical interventions to induce labour in outpatient settings in terms of feasibility, effectiveness, maternal satisfaction, healthcare costs and, where information is available, safety. The review complements existing reviews on labour induction examining effectiveness and safety. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (December 2009) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials examining outpatient cervical ripening or induction of labour with pharmacological agents or mechanical methods. Data collection and analysis Two authors independently extracted data and assessed eligible papers for risk of bias. We checked all data after entry into review manager software. Main results We included 28 studies with 2616 women examining different methods of induction of labour where women received treatment at home or were sent home after initial treatment and monitoring in hospital. Studies examined vaginal and intracervical PGE2, vaginal and oral misoprostol, isosorbide mononitrate, mifepristone, oestrogens, and acupuncture. Overall, the results demonstrate that outpatient induction of labour is feasible and that important adverse events are rare. There was no strong evidence that agents used to induce labour in outpatient settings had an impact (positive or negative) on maternal or neonatal health. There was some evidence that, compared to placebo or no treatment, induction agents reduced the need for further interventions to induce labour, and shortened the interval from intervention to birth. We were unable to pool results on outcomes relating to progress in labour as studies tended to measure a very broad range of outcomes. There was no evidence that induction agents increased interventions in labour such as operative deliveries. Only two studies provided information on women’s views about the induction process, and overall there was very little information on the costs to health service providers of different methods of labour induction in outpatient settings. Authors’ conclusions Induction of labour in outpatient settings appears feasible. We do not have sufficient evidence to know which induction methods are preferred by women, or the interventions that are most effective and safe to use in outpatient settings.

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Section: Introductionmentioning

confidence: 99%

Different methods for the induction of labour in outpatient settings

Dowswell¹,

Kelly²,

Livio³

et al. 2010

Cochrane Database of Systematic Reviews

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“…Changes in the cervix during pre-induction cervical ripening are among the factors utilized for evaluation of cervix when performing induction. [ 1 2 ]…”

Section: Introductionmentioning

confidence: 99%

“…There are considerable studies conducted on various methods of cervical ripening prior to stimulating uterine contractions. [ 2 3 ] A Bishop score of 4 or lower indicates inappropriate cervix, and might be inclusions for indication of pre-induction cervical ripening. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Comparing the effect of oral and vaginal isosorbide dinitrate in pre-induction cervical ripening in term pregnancy: A controlled clinical trial

2015

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Background:Cervical ripening for labor induction is one of the most important issues in midwifery. Isosorbide dinitrate (ISDN) is one of the most important choices that have been proposed for cervical ripening, but still there are controversies regarding its prescription. The present study aimed to evaluate the effects of vaginal and oral ISDN compared to the control group for pre-induction cervical ripening.Materials and Methods:In this non-blinded clinical trial, 149 nulliparous women with term or prolonged pregnancy were randomly selected and divided into three groups by block randomization. The intervention group included vaginal (50 subjects, 40 mg) and oral (49 subjects, 20 mg) ISDN groups. The third group was the control group (50 subjects) which did not receive any medication. The amount of ripening was given by Bishop score evaluated before taking medication and 24 h after taking it.Results:After 24 h, Bishop score in vaginal ISDN group significantly increased compared to the oral ISDN and control groups (P < 0.001 for both). Although the increase in Bishop score was lower in the oral ISDN group than in the vaginal group, it had a statistically significant increase in comparison to the control group (P = 0.001). All the three groups were matched regarding pregnancy termination and cesarean causes, and there was no statistically significant difference among the three groups (P > 0.05).Conclusion:Prescribing vaginal ISDN for cervical ripening was effective, and it can be used with confidence.

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