Outpatient versus inpatient induction of labour

Kelly AJ, Alfirevic Z, Dowswell T

Published Online:

April 15, 2009

Up to a quarter of pregnant women may need their labour started artificially, or induced, with the use of medication or by other means. With most methods of induction it takes some time for labour to actually start. This means that it may be more convenient to women, and cheaper for health service providers, if they are cared for in outpatient settings, such as in their own homes. Women who are at low obstetric or medical risk could be assessed in hospital, given the induction agent and then return home with clear instructions. The use of outpatient induction of labour attempts to balance possible improvements in maternal satisfaction, convenience, reduced length of stay in hospital and lower cost with the safety of both the mother and baby.

Three randomised controlled trials with a combined total of 612 women assessed the effects of induction of labour for women managed as outpatients versus inpatients. The induction agents differed in each trial. The limited information from these trials did not support more successful induction within 24 hours, shorter length of stay in hospital or differences in need for further induction or the mode of giving birth. The information available was limited and it is, therefore, not yet possible to determine whether induction of labour is effective and safe in outpatient settings.

Abstract (click to read)

Background:

More than 20% of women undergo induction of labour in some countries. The different methods used to induce labour have been the focus of previous reviews, but the setting in which induction takes place (hospital versus outpatient settings) may have implications for maternal satisfaction and costs. It is not known whether some methods of induction that are effective and safe in hospital are suitable in outpatient settings.

Objectives:

To assess the effects on outcomes for mothers and babies of induction of labour for women managed as outpatients versus inpatients.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2008).

Selection criteria:

Published and unpublished randomised and quasi-randomised trials in which inpatient and outpatient methods of cervical ripening or induction of labour have been compared.

Data collection and analysis:

Two review authors independently assessed trial reports for inclusion. Two review authors carried out data extraction and assessment of risk of bias independently.

Main results:

We included three trials, with a combined total of 612 women in the review; each examined a different method of induction and we were unable to pool the results from trials.

1. Vaginal PGE2 (One study including 201 women). There were no differences between women managed as out- versus inpatients for most review outcomes. Women in the outpatient group were more likely to have instrumental deliveries (risk ratio (RR) 1.74; 95% confidence interval (CI) 1.03 to 2.93). The overall length of hospital stay was similar in the two groups.

2. Controlled release PGE2 10mg (one study including 300 women). There was no evidence of differences between groups for most review outcomes, including success of induction. During the induction period itself, women in the outpatient group were more likely to report high levels of satisfaction with their care (satisfaction rated seven or more on a nine-point scale RR 1.42; 95% CI 1.11 to 1.81), but satisfaction scores measured postnatally were similar in the two groups.

3. Foley catheter (one study including 111 women). There was no evidence of differences between groups for caesarean section rates, total induction time and the numbers of babies admitted to neonatal intensive care.

Authors' conclusions:

The data available to evaluate the efficacy or potential hazards of outpatient induction are limited. It is, therefore, not yet possible to determine whether induction of labour is effective and safe in outpatient settings.

This record should be cited as:

Kelly AJ, Alfirevic Z, Dowswell T. Outpatient versus inpatient induction of labour for improving birth outcomes. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007372. DOI: 10.1002/14651858.CD007372.pub2

Assessed as up to date:

December 28, 2008

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Induction of labour > Other

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Outpatient versus inpatient induction of labour

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