Abstract
BackgroundAs the number of indications for labour induction continue to increase, the focus has shifted to performing these procedures in an outpatient setting. This study aims to systematically review published data from randomized controlled trials that compare outpatient with inpatient labour induction, to ascertain the role of outpatient labour induction for low-risk pregnancies.MethodsWe conducted a systematic review wherein we searched MEDLINE, EMBASE, Biosis Previews®, and International Pharmaceutical s from inception to January 2020 to identify randomized controlled trials that reported on maternal, fetal and resource-related outcomes following outpatient versus inpatient labour induction. Pooled incidences and mean differences were calculated using random-effects meta-analysis. Risk-of-bias was assessed using the Cochrane Risk of Bias tool. Subgroup analysis was conducted based on the method of induction.ResultsOf the 588 records identified, 12 publications, representing nine independent randomized controlled trials conducted in Australia, Europe and North America, were included. These reported on 2615 cases of labour induction (1320 outpatients versus 1295 inpatients). Overall, apart from a higher number of suspicious fetal heart rate tracings [RR = 1.43 (1.10, 1.86)] and a shorter mean length of hospital stay [MD = 282.48 min (160.23, 404.73) shorter] in the outpatient group, there were no differences in delivery method, adverse outcomes or resource-use between the two arms. On subgroup analysis, when comparing the use of balloon catheters in both arms, those induced as outpatients had fewer caesarean deliveries [RR = 0.52 (0.30, 0.90)], a shorter admission-to-delivery interval [MD = 370.86 min (19.19, 722.54) shorter], and a shorter induction to delivery interval [MD = 330.42 min (120.13, 540.71) shorter].ConclusionOutpatient labour induction in resource-rich settings is at least as effective and safe, in carefully selected patient populations, when compared with inpatient labour induction. Whether outpatient labour induction results in lower rates of caesarean deliveries needs to be explored further.Trial registrationThis systematic review was prospectively registered in Prospero (CRD42019118049).
Highlights
As the number of indications for labour induction continue to increase, the focus has shifted to performing these procedures in an outpatient setting
The studies reported on 2615 pregnancies, with 1320 pregnancies induced in the outpatient setting, and 1295 in the inpatient setting
In conclusion, this systematic review of randomized controlled trials comparing inpatient vs. outpatient labour induction reveals that outpatient labour induction in resource-rich settings is at least as effective and safe, if not more, in carefully-selected patient populations, when compared with inpatient inductions
Summary
As the number of indications for labour induction continue to increase, the focus has shifted to performing these procedures in an outpatient setting. This study aims to systematically review published data from randomized controlled trials that compare outpatient with inpatient labour induction, to ascertain the role of outpatient labour induction for low-risk pregnancies. Outpatient cervical ripening can be an attractive option to theoretically reduce length of antenatal stay in hospital, reduce strain on healthcare resources, increase maternal satisfaction and comfort, and potentially reduce financial costs. Its uptake remains highly variable [4, 5], presumably due to a number of cultural and resource-related factors, as well as concerns with regard to its safety and efficacy. We sought to systematically review the literature, reporting all randomized controlled trials that compared outpatient to inpatient labour induction, to evaluate its safety and efficacy
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