Reported Experience With Intracervical Ripening Bulb for Outpatient Induction of Labor at Term [18I

Abstract

INTRODUCTION: Outpatient cervical ripening using an intracervical balloon catheter offers promise for outpatient preinduction of labor. Published studies are limited by small sample sizes. METHODS: We searched Medline, Web of Science™, Cochrane database, and clinicaltrials.gov for meta-analysis of studies evaluating outpatient cervical ripening with intracervical balloon catheters. We included randomized, controlled trials comparing outpatient intracervical balloon versus inpatient cervical ripening. Outcomes of interest were time spent hospitalized before delivery, total induction time, cesarean delivery rate, need for oxytocin, and 5-minute APGAR score. Our search yielded three studies for inclusion. All three were performed at different institutions and met the following criteria: gestational age 37 weeks or more and suitable for outpatient cervical ripening, initial Bishop score less than 7, no intrauterine growth restriction, intact membranes, and reassuring initial fetal heart rate tracing. All groups were analyzed in an intention-to-treat fashion. RESULTS: The three studies totaled 260 women who were randomized into outpatient (n=144) and inpatient (n=116) groups. Maternal age, parity, and gestational age did not differ between groups. The total induction time, mean total time on oxytocin, rate of epidural use, 5-minute APGAR scores, rate of delivery within 24 hours of induction, and rate of post-partum hemorrhage did not differ between groups. The outpatient group spent an average of 8.6 fewer hours in the hospital before delivery (P=.001) but were more likely to require oxytocin (OR 2.74, P=.032). CONCLUSION: Outpatient cervical ripening with an inflatable bulb catheter appears to be acceptable in a low-risk, term population with an unfavorable cervix.