Prostaglandin insert dinoprostone versus trans-cervical balloon catheter for outpatient labour induction: a randomised controlled trial of feasibility (PROBIT-F)

Bhide, A.; Sedgwick, Philip; Barrett, Barbara; Cupples, Georgina; Coates, Rose; Goode, Rosie; Linton, Sandra; McCourt, Christine

doi:10.1186/s40814-020-00661-7

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…It is worth noting, however, that in none of the studies found the obstetric results in the group of MVI-induced patients were worse than in the DVI 9 , 14 , 15 , 17 , which also applies to patients with hypertensive disorders of pregnancy 18 and patients who experienced adverse events after using MVI or DVI 10 , although in this last case the cited analysis seems to have too little statistical power to detect differences. Relatively high safety of DVI results in attempts to use it in an outpatient setting 19 , combining it with mechanical pre-induction using a Foley catheter 20 and in patients after CS 21 . An undoubted advantage of MVI is the registration for use during pregnancy from 36 weeks and in the case of the rupture of the membranes.…”

Section: Discussionmentioning

confidence: 99%

Misoprostol vs dinoprostone vaginal insert in labour induction: comparison of obstetrical outcome

Młodawski

Mlodawska

Armanska³

et al. 2021

Sci Rep

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Induction of labour (IOL) is increasingly used in obstetric practice. For patients with unfavourable cervix, we are constantly looking for an optimal, in terms of effectiveness and safety, ripening of cervix protocol. It was retrospective cohort study. We analyzed obstetrical results in 481 patients undergoing IOL in one center using two different vaginal inserts that release prostaglandins at a constant rate for 24 h—misoprostol vaginal insert (MVI) with 200 µg of misoprostol (n = 367) and dinoprostone vaginal insert (DVI) with 10 mg of dinoprostone (n = 114). Full-term, single pregnancy patients with intact fetal membranes and the cervix evaluated in Bishop score ≤ 6 were included in the analysis. In the group of MVI patients, the labour ended with caesarean section more often (OR 2.71 95% CI 1.63–4.47) and more frequent unreassuring cardiotocographic trace indicating the surgical delivery occurred (OR 2.38 95% CI 1.10–5.17). We did not notice any differences in the percentage of vacuum extraction and patients in whom the use of oxytocin was necessary during labour induction. The clinical status of newborns after birth and the pH of cord blood did not differ between groups.The use of MVI 200 μg in patients with an unriped cervix is associated with a greater chance of completing delivery by caesarean section and increased chance of abnormal intrapartum CTG trace compared to the use of DVI 10 mg. These differences do not affect the clinical and biochemical status of the newborn.

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Section: Discussionmentioning

confidence: 99%

Misoprostol vs dinoprostone vaginal insert in labour induction: comparison of obstetrical outcome

Młodawski

Mlodawska

Armanska³

et al. 2021

Sci Rep

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“…In that study, 71.9% of the women with IOL received outpatient care. Other studies on outpatient IOL using other IOL methods report proportions of eligible women ranging from 8.3% to 53.0% 21–23 . Although eligibility criteria for outpatient IOL are not described in detail in all the papers, the published criteria seem comparable to the LINO study criteria, with some differences regarding women with hypertension, preeclampsia, diabetes, and small‐for‐gestational‐age fetuses.…”

Section: Discussionmentioning

confidence: 99%

Outpatient labor induction—Exploring future potential by assessing eligibility in a historical cohort

Marsdal,

Sørbye,

Bernitz

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionLabor induction rates have increased over the last decades, and in many high‐income countries, more than one in four labors are induced. Outpatient management of labor induction has been suggested in low‐risk pregnancies to improve women's birth experiences while also promoting a more efficient use of healthcare resources. The primary aim of this paper was to assess the proportion of women in a historical cohort that would have been eligible for outpatient labor induction with oral misoprostol. Second, we wanted to report safety outcomes and assess efficacy outcomes for mothers and infants in pregnancies that met the criteria for outpatient care.Material and methodsCriteria for outpatient labor induction with oral misoprostol were applied to a historical cohort of women with induction of labor at two Norwegian tertiary hospitals in the period January 1, through July 31, 2021. The criteria included low‐risk women with an unscarred uterus expecting a healthy, singleton baby in cephalic position at term. The primary outcome was the proportion of women eligible for outpatient labor induction. Secondary outcomes included reasons for ineligibility and, for eligible women, safety and efficacy outcomes.ResultsOverall, 29.7% of the 1320 women who underwent labor induction in a singleton term pregnancy met the criteria for outpatient labor induction. We identified two serious adverse events that potentially could have occurred outside the hospital if the women had received outpatient care. The mean duration from initiation of labor induction to administration of the last misoprostol was 22.4 h. One in 14 multiparous women gave birth within 3 h after the last misoprostol dose.ConclusionsIn this historical cohort, three in ten women met the criteria for outpatient management of labor induction with oral misoprostol. Serious adverse events were rare. The average time span from the initiation of labor induction to the last misoprostol was nearly 24 h. This suggests a potential for low‐risk women with an induced labor to spend a substantial period of time at home before labor onset. However, larger studies testing or evaluating labor induction with oral misoprostol as an outpatient procedure are needed to draw conclusions.

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“…With the ongoing COVID-19 pandemic, there is an additional incentive to reduce the burden on hospital resourcesand to safely keep patients out of the hospital. Furthermore, publishing on outpatient cervical ripening increased dramatically in 2020 showing a global increase in interest (7,8,16,(35)(36)(37)(38)(39).…”

Section: Discussionmentioning

confidence: 99%

Out-of-Hospital Cervical Ripening With a Synthetic Hygroscopic Cervical Dilator May Reduce Hospital Costs and Cesarean Sections in the United States—A Cost-Consequence Analysis

Saunders

Wong³

et al. 2021

Front. Public Health

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Objective: Out-of-hospital (outpatient) cervical ripening prior to induction of labor (IOL) is discussed for its potential to decrease the burden on hospital resources. We assessed the cost and clinical outcomes of adopting an outpatient strategy with a synthetic hygroscopic cervical dilator, which is indicated for use in preinduction cervical ripening.Methods: We developed a cost-consequence model from the hospital perspective with a time period from IOL to post-delivery discharge. A hypothetical cohort of women to undergo IOL at term with an unfavorable cervix (all risk levels) were assessed. As the standard of care (referred to as IP-only) all women were ripened as inpatients using the vaginal PGE2 insert or the single-balloon catheter. In the comparison (OP-select), 50.9% of low-risk women (41.4% of the study population) received outpatient cervical ripening using a synthetic hygroscopic cervical dilator and the remaining women were ripened as inpatients as in the standard of care. Model inputs were sourced from a structured literature review of peer-reviewed articles in PubMed. Testing of 2,000 feasible scenarios (probabilistic multivariate sensitivity analysis) ascertained the robustness of results. Outcomes are reported as the average over all women assessed, comparing OP-select to IP-only.Results: Implementing OP-select resulted in hospital savings of US$689 per delivery, with women spending 1.48 h less time in the labor and delivery unit and 0.91 h less in the postpartum recovery unit. The cesarean-section rate was decreased by 3.78 percentage points (23.28% decreased to 19.50%). In sensitivity testing, hospital costs and cesarean-section rate were reduced in 91% of all instances.Conclusion: Our model analysis projects that outpatient cervical ripening has the potential to reduce hospital costs, hospital stay, and the cesarean section rate. It may potentially allow for better infection-prevention control during the ongoing COVID-19 pandemic and to free up resources such that more women might be offered elective IOL at 39 weeks.

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Prostaglandin insert dinoprostone versus trans-cervical balloon catheter for outpatient labour induction: a randomised controlled trial of feasibility (PROBIT-F)

Cited by 11 publications

References 14 publications

Misoprostol vs dinoprostone vaginal insert in labour induction: comparison of obstetrical outcome

Misoprostol vs dinoprostone vaginal insert in labour induction: comparison of obstetrical outcome

Outpatient labor induction—Exploring future potential by assessing eligibility in a historical cohort

Out-of-Hospital Cervical Ripening With a Synthetic Hygroscopic Cervical Dilator May Reduce Hospital Costs and Cesarean Sections in the United States—A Cost-Consequence Analysis

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