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

Abstract

BackgroundsOutpatient induction of labor (IOL) is an alternative choice offered to pregnant women requiring cervical ripening. Outpatient IOL can provide solutions in terms of women empowerment, but most importantly promotes as normal labor as possible, within the medical context of the IOL. The objectives of this systematic review were to assess safety and effectiveness of cervical ripening performed with a slow‐release dinoprostone vaginal insert in term pregnancies in two settings: the outpatient (home) versus the inpatient (hospital).MethodsThe electronic databases Cinahl, Embase, Medline and Maternity and Infant Care were searched to detect studies that met the inclusion criteria. Both reviewers collected the data and assessed the quality of the studies and assessed the pooled odds ratio using a 95% confidence interval and a random‐effects model. Primary outcomes were linked to maternal and neonatal morbidity. Secondary outcomes were related to birth outcomes.ResultsNo statistical difference was seen between the outpatient and inpatient setting in terms of maternal complications, neonatal morbidity, cesarean section, and labor onset <24 h. Women in the outpatient setting were significantly less likely to experience uterine hyperstimulation, and they were also significantly more likely to require oxytocin to augment or induce their labor than the women in the inpatient setting. Women in the outpatient setting were more satisfied with the cervical ripening experience.ConclusionsCervical ripening with a slow‐release dinoprostone vaginal insert in term pregnancies in the outpatient setting appears as safe as the inpatient setting in terms of maternal, neonatal, and birth outcomes.

Experience of dinoprostone vaginal insert using for cervical ripening and induction of labor

“…В клинической практике для подготовки шейки матки к родам в настоящее время широко применяют фармакологические препараты простагландинов Е1 и Е2 [6]. В Российской Федерации (РФ) для преиндукции и индукции родов сертифицирован только препарат простагландина Е2 -динопростон, который выпускают в форме геля (интрацервикального) и вставки-вкладыша (системы вагинальной терапевтической; СВТ) [7].…”