Kuper SG, et al. - Whether or not outpatient cervical ripening with a transcervical Foley catheter in parous women undergoing elective induction of labor shortens the total duration of time from admission to the labor ward until delivery was investigated. Parous women do not demonstrate shortened time from labor ward admission until delivery in association with outpatient cervical ripening if oxytocin is initiated simultaneously with inpatient transcervical catheter placement.

Methods

• At a single academic center, researchers performed an open-label randomized controlled trial including parous women at 39 weeks of gestation or greater with a cervix 3 cm or less dilated, or, if 2–3 cm dilated, less than 80% effaced and reassuring fetal heart rate monitoring (defined as moderate variability with a normal baseline and absence of decelerations).
• Patients with following conditions were excluded: obstetric and neonatal conditions deemed unsuitable for outpatient cervical ripening, contraindications to vaginal delivery, or conditions that required immediate hospitalization.
• In the ambulatory setting, they randomized the women to either an outpatient transcervical catheter (with immediate placement) or inpatient transcervical catheter placement and concomitant oxytocin infusion on the labor ward.
• They instructed women comprising the outpatient group to return to the hospital the next day or sooner if labor occurred.
• Management of induction of labor was performed per institutional protocol, and oxytocin was initiated once participants were admitted.
• The duration of time from labor ward admission until delivery was assessed as the primary outcome.
• A prior study performed at their institution suggested a necessity for a total of 128 women for 80% power to detect a 12-hour difference in total duration spent from labor ward admission until delivery with a two-sided α of 0.05.

Results

• Researchers screened 743 women from May 2016 to October 2017.
• Of these,129 provided consent and were randomized.
• The groups were balanced in terms of baseline characteristics.
• No significantly shortened time from labor ward admission until delivery was observed with outpatient cervical ripening (12.4±7.4 vs 13.5±7.0 hours, P=.38).