Outpatient Cervical Ripening Program Evaluation: A Comparison of Osmotic Cervical Dilators and Foley Balloon [ID: 1377400

Abstract

INTRODUCTION: With increased demand for elective and medically indicated inductions of labor, outpatient cervical ripening programs have the potential to increase clinical efficiency, decrease costs, and promote patient satisfaction. This study describes patient characteristics, process, and outcome measures for an outpatient cervical ripening program. METHODS: This retrospective cohort study examined low-risk women (39–40 6/7 weeks) undergoing outpatient cervical ripening with osmotic cervical dilators (Dilapan-S) or Foley balloon from March 2020 to March 2022. Outcomes included mode of delivery, obstetric complications, and changes in cervical dilation and simplified Bishop score (SBS) (a 0- to 9-point scoring system based on dilatation, effacement, and station). RESULTS: One hundred twenty patients completed outpatient cervical ripening (80 osmotic dilators, 40 Foley). Foley patients were less likely to be White and had higher SBS at insertion. 16.7% (n=20) of patients returned before scheduled induction, primarily because of contractions. Device expulsion prior to admission was more common among Foley patients (27.5%) than osmotic dilators (6.3%). Mean time from insertion to admission was 17.5 hours for osmotic dilators and 13.6 hours for Foley. The mean SBS change was 1.78, and mean dilation change was 1.83 cm with no differences by device type. Mean time from admission to delivery was 20.96 (15.36) hours, and 74.2% of patients delivered vaginally, with no difference by device type in adjusted models. Rates of infection (4.2%), and postpartum hemorrhage (2.3% vaginal, 32% cesarean) did not differ by device. CONCLUSION: Outpatient cervical ripening with osmotic cervical dilators or Foley improves SBS on admission with low complications and no significant differences in outcomes by device.