References

Adelson PL, Wedlock GR, Wilkinson CS, Howard K, Bryce RL, Turnbull DA. A cost analysis of inpatient compared with outpatient prostaglandin E2 cervical priming for induction of labour: results from the OPRA trial. Aust Health Rev. 2013; 37:(4)467-73 https://doi.org/https://doi.org/10.1071/AH13081

Alfirevic Z, Aflaifel N, Weeks A. Oral misoprostol for induction of labour. Cochrane Database Syst Rev. 2014; 13:(6)

Alfirevic Z, Keeney E, Dowswell T Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG. 2016; 123:(9)1462-70 https://doi.org/https://doi.org/10.1111/1471-0528.13981

Arai L, Britten N, Popay J Testing methodological developments in the conduct of narrative synthesis: a demonstration review of research on the implementation of smoke alarm interventions. Evidence & Policy. 2007; 3:(3)361-83 https://doi.org/https://doi.org/10.1332/174426407781738029

Awartani KA, Turnell RW, Olatunbosun OA. A prospective study of induction of labor with prostaglandin vaginal gel: ambulatory versus in-patient administration. Clin Exp Obstet Gynecol. 1999; 26:(3-4)162-5

Bettany-Saltikov J, McSherry R. How to do a systematic literature review in nursing, 2nd edn. Oxford: Open University Press; 2016

Biem SRD, Turnell RW, Olatunbosun O, Tauh M, Biem HJ. A randomized controlled trial of outpatient versus inpatient labour induction with vaginal controlled-release prostaglandin-E2: effectiveness and satisfaction. J Obstet Gynaecol Can. 2003; 25:(1)23-31 https://doi.org/https://doi.org/10.1016/S1701-2163(16)31079-9

Bond DM, Middleton P, Levett KM Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 2017; 3

Booth A, Papaioannou D, Sutton A. Systematic approaches to a successful literature review, 2nd edn. London: Sage; 2016

Patterns of maternity care in English NHS Hospitals 2013/14. 2016. https://indicators.rcog.org.uk/media/2016/03/22/10/43/57/597e02e7-9042-4af6-a5ce-e3cd99745eb0/Maternity%20indicators%202013.14_final.pdf (accessed 20 March 2016)

Systematic Reviews: CRD's Guidance for Undertaking Reviews in Healthcare.York: University of York; 2009

Critical Appraisal Skills Programme. CASP Checklists. 2013. http://www.casp-uk.net/checklists (accessed 24 Decemeber 2016)

Cundiff GW, Simpson ML, Koenig N, Lee T. Observational study of neonatal safety for outpatient labour induction priming with dinoprostone vaginal insert. J Obstet Gynaecol Can. 2017; 39:(5)354-60 https://doi.org/https://doi.org/10.1016/j.jogc.2017.01.003

Darzi A. Quality and the NHS next stage review. Lancet. 2008; 371:(9624)1563-64 https://doi.org/https://doi.org/10.1016/S0140-6736(08)60672-8

Department of Health. High Quality Care for All. 2008. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/228836/7432.pdf (accessed 30 June 2017)

Dhavliker M, Abdulai K, Davy J, Vinayagam D, Hughes P. Outpatient induction of labour using Propess (R) in low-risk women—is it acceptable without compromising the clinical outcome?. BJOG. 2016; 123:42-3

Farmer KC, Schwartz WJ, Rayburn WF, Turnbull G. A cost-minimization analysis of intracervical prostaglandin E2 for cervical ripening in an outpatient versus inpatient setting. Clin Ther. 1996; 18:(4)747-56 https://doi.org/https://doi.org/10.1016/S0149-2918(96)80224-4

Gommers JSM, Diederen M, Wilkinson C, Turnbull D, Mol BWJ. Risk of maternal, fetal and neonatal complications associated with the use of the transcervical balloon catheter in induction of labour: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2017; 218:73-84 https://doi.org/https://doi.org/10.1016/j.ejogrb.2017.09.014

Grobman WA. Is it time for outpatient cervical ripening with prostaglandins?. BJOG. 2015; 122:(1) https://doi.org/https://doi.org/10.1111/1471-0528.12849

Harden A, Brunton G, Fletcher A, Oakley A, Burchett H, Backhans M. Young people, pregnancy and social exclusion: a systematic synthesis of research evidence to identify effective, appropriate and promising approaches for prevention and support.London: University of London; 2006

Henry A, Madan A, Reid R Outpatient foley catheter versus inpatient prostaglandin E2 gel for induction of labour: a randomised trial. BMC Pregnancy Childbirth. 2013; 13:(1) https://doi.org/https://doi.org/10.1186/1471-2393-13-25

Howard K, Gerard K, Adelson P, Bryce R, Wilkinson C, Turnbull D. Women's preferences for inpatient and outpatient priming for labour induction: a discrete choice experiment. BMC Health Serv Res. 2014; 14:(1) https://doi.org/https://doi.org/10.1186/1472-6963-14-330

Hunt K, Lathlean J. Sampling, 7th edn. In: Gerrish K, Lathlean J (eds). Chichester: John Wiley & Sons; 2015

Jozwiak M, Bloemenkamp KWM, Kelly AJ, Mol BWJ, Irion O, Boulvain M. Mechanical methods for induction of labour. Cochrane Database Syst Rev. 2012; 2012:(3)

Kelly AJ, Alfirevic Z, Ghosh A. Outpatient versus inpatient induction of labour for improving birth outcomes. Cochrane Database Syst Rev. 2013; (11)

Lathlean J. Qualitative Analysis, 7th edn. In: Gerrish K, Lathlean J (eds). Chichester: John Wiley & Sons; 2015

McMaster K, Sanchez-Ramos L, Kaunitz AM. Evaluation of a transcervical foley catheter as a source of infection. Obstet Gynecol. 2015; 126:(3)539-51 https://doi.org/https://doi.org/10.1097/AOG.0000000000001002

Murtagh M, Folan M. Womens experiences of induction of labour for post-date pregnancy. British Journal of Midwifery. 2014; 22:(2)105-10 https://doi.org/https://doi.org/10.12968/bjom.2014.22.2.105

Antenatal care: routine care for the healthy pregnant woman.London: RCOG Press; 2008

Neale E, Pachulski A, Whiterod S, McGuinness E, Gallagher N, Wallace R. Outpatient cervical ripening prior to induction of labour. J Obstet Gynaecol. 2002; 22:(6)634-35 https://doi.org/https://doi.org/10.1080/0144361021000020411

Nelson A, Dumville J, Torgerson D. Experimental Research, 7th edn. In: Gerrish K, Lathlean J (eds). Chichester: John Wiley & Sons; 2015

NHS Digital. Hospital Maternity Activity: England, 2015-16. 2016. http://digital.nhs.uk/media/29879/Hospital-Maternity-Activity-2015-16-Summary-Report/Any/hosp-epis-stat-mat-summ-repo-2015-16-rep (accessed 31 October 2017)

O'Brien E, Rauf Z, Alfirevic Z, Lavender T. Womens experiences of outpatient induction of labour with remote continuous monitoring. Midwifery. 2013; 29:(4)325-31 https://doi.org/https://doi.org/10.1016/j.midw.2012.01.014

O'Dwyer S, Raniolo C, Roper J, Gupta M. Improving induction of labour—a quality improvement project addressing caesarean section rates and length of process in women undergoing induction of labour. BMJ Qual Improv Rep. 2015; 4:(1)

Okunoye G, Bandyopadhyay D, Leigh-Atkins S. In-patient cervical priming for postdate induction of labour in low risk women: it is time for a rethink. BJOG. 2015; 122:(S1)

Oster C, Adelson PL, Wilkinson C, Turnbull D. Inpatient versus outpatient cervical priming for induction of labour: therapeutic landscapes and womens preferences. Health Place. 2011; 17:(1)379-85 https://doi.org/https://doi.org/10.1016/j.healthplace.2010.12.001

Polit D, Beck C. Essentials of nursing research, 6th edn. Philadelphia: Lippincott Williams and Wilkins; 2006

Rattray J, Jones MC. Essential elements of questionnaire design and development. J Clin Nurs. 2007; 16:(2)234-43 https://doi.org/https://doi.org/10.1111/j.1365-2702.2006.01573.x

Rauf Z, Alfirevic Z. Continuous remote fetal monitoring with MONICA AN24 during home induction of labor. Am J Obstet Gynecol. 2011; 204:(1)S1-S263 https://doi.org/https://doi.org/10.1016/j.ajog.2010.10.686

Rauf Z, OBrien E, Stampalija T, Popescu F, Lavender T, Alfirevic Z. Remote fetal ECG monitoring and outpatient labour induction. Arch Dis Child Fetal Neonatal Ed. 2011; 96:Fa79-80 https://doi.org/https://doi.org/10.1136/archdischild.2011.300162.17

Reid M, Lorimer K, Norman JE, Bollapragada SS, Norrie J. The home as an appropriate setting for women undertaking cervical ripening before the induction of labour. Midwifery. 2011; 27:(1)30-5 https://doi.org/https://doi.org/10.1016/j.midw.2009.11.003

Salvador SC, Lynn Simpson M, Cundiff GW. Dinoprostone vaginal insert for labour induction: a comparison of outpatient and inpatient settings. J Obstet Gynaecol Can. 2009; 31:(11)1028-34 https://doi.org/https://doi.org/10.1016/S1701-2163(16)34347-X

Sharp AN, Stock SJ, Alfirevic Z. Outpatient induction of labour in the UK: a survey of practice. Eur J Obstet Gynecol Reprod Biol. 2016; 204:21-3 https://doi.org/https://doi.org/10.1016/j.ejogrb.2016.06.023

Stock SJ, Taylor R, Mairs R Home cervical ripening with dinoprostone gel in nulliparous women with singleton pregnancies. Obstet Gynecol. 2014; 124:(2, PART 1)354-60 https://doi.org/https://doi.org/10.1097/AOG.0000000000000394

Thomas J, Fairclough A, Kavanagh J, Kelly AJ. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database Syst Rev. 2014; (6)

Turnbull D, Adelson P, Oster C, Bryce R, Fereday J, Wilkinson C. Psychosocial outcomes of a randomized controlled trial of outpatient cervical priming for induction of labor. Birth. 2013; 40:(2)75-80 https://doi.org/https://doi.org/10.1111/birt.12035

Wilkinson C, Bryce R, Adelson P, Turnbull D. A randomised controlled trial of outpatient compared with inpatient cervical ripening with prostaglandin E 2 (OPRA study). BJOG. 2015; 122:(1)94-104 https://doi.org/https://doi.org/10.1111/1471-0528.12846

Wing DA, Brown R, Plante LA, Miller H, Rugarn O, Powers BL. Misoprostol vaginal insert and time to vaginal delivery: a randomized controlled trial. Obstet Gynecol. 2013; 122:(2, PART 1)201-9 https://doi.org/https://doi.org/10.1097/AOG.0b013e31829a2dd6

Outpatient induction of labour with prostaglandins: Safety, effectiveness and women's views

02 December 2017
14 min read
Volume 25 · Issue 12

Abstract

Background

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.

Aim

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.

Method

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.

Findings

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.

Conclusion

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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