Outpatient induction of labour with prostaglandins: Safety, effectiveness and women's views
Nearly 28% of women underwent induction of labour in England in 2015-16. Women frequently report delays and poor experiences, and the process can put additional pressure on busy labour wards. Outpatient induction of labour (OPIOL) enables women to return home to await the onset of contractions.
To explore the research about OPIOL using prostaglandins and to identify gaps in the evidence base. Outcomes will be compared with those induced as inpatients.
An electronic search was conducted to identify relevant studies using keywords. Once the studies had been identified, a narrative synthesis of the findings was conducted.
Adverse outcomes were rare but studies were not sufficiently powered to detect significant differences between outpatients and inpatients. There were some differences in cost and effectiveness that may be explained by disparities in study design, participant characteristics and operational issues. Time avoided in hospital by outpatients ranged from 7.5–11.76 hours. Satisfaction was generally higher with OPIOL, although some women expressed apprehension about being at home.
While OPIOL with prostaglandins is acceptable to women, it is not clear whether there are significant differences in safety and effectiveness outcomes, due to the low frequency of adverse perinatal events as well as methodological and quality issues of the included studies. Further research is needed to compare outcomes, maternal experiences and cost effectiveness of OPIOL.
Induction of labour is a procedure that is offered to women when it is considered that giving birth is of greater benefit to the mother or baby than remaining pregnant (Thomas et al, 2014). Labour may be induced by pharmacological, mechanical and surgical means (National Collaborating Centre for Women's and Children's Health (NCCWCH), 2008). These methods are used to stimulate maternal production of prostaglandins to ripen the cervix so that it starts to soften and dilate, stimulating uterine contractions. Data shows that 27.9% of women underwent induction in England in 2015-16 for fetal or maternal reasons, prolonged rupture of membranes or post-maturity (NHS Digital, 2016). However, women frequently report poor experiences, lack of information and autonomy, poor support and long delays (Reid et al, 2011; Murtagh and Folan 2014; O'Dwyer et al, 2015) and the process can increase workload on busy labour wards (NCCWCH, 2008; Kelly et al, 2013; Carroll et al, 2016).
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