Journal Article

Outpatient Foley catheter versus inpatient prostaglandin E2 gel for induction of labour: a randomised trial

Austin, Kathryn, Tracy, Sally K, Henry, Amanda, Reid, Rachel, Welsh, Alec, Madan, Arushi, Challis, Daniel

2013

Overview

Background Induction of labour (IOL) is one of the commonest obstetric interventions, with significant impact on both the individual woman and health service delivery. Outpatient IOL is an attractive option to reduce these impacts. To date there is little data comparing outpatient and inpatient IOL methods, and potential safety concerns (hyperstimulation) if prostaglandins, the standard inpatient IOL medications, are used in the outpatient setting. The purpose of this study was to assess feasibility, clinical effectiveness and patient acceptability of outpatient Foley catheter (OPC) vs. inpatient vaginal PGE2 (IP) for induction of labour (IOL) at term. Methods Women with an unfavourable cervix requiring IOL at term (N = 101) were randomised to outpatient care using Foley catheter (OPC, n = 50) or inpatient care using vaginal PGE2 (IP, n = 51). OPC group had Foley catheter inserted and were discharged overnight following a reassuring cardiotocograph. IP group received 2 mg/1 mg vaginal PGE2 if nulliparous or 1 mg/1 mg if multiparous. Main outcome measures were inpatient stay (prior to birth, in Birthing Unit, total), mode of birth, induction to delivery interval, adverse reactions and patient satisfaction. Results OPC group had shorter hospital stay prior to birth (21.3 vs. 32.4 hrs, p < .001), IP were more likely to achieve vaginal birth within 12 hours of presenting to Birthing Unit (53% vs. 28%, p = .01). Vaginal birth rates (66% OPC Vs. 71% IP), total induction to delivery time (33.5 hrs vs. 31.3 hrs) and total inpatient times (96 hrs OPC Vs. 105 hrs IP) were similar. OPC group felt less pain (significant discomfort 26% Vs 58%, p = .003), and had more sleep (5.8 Vs 3.4 hours, p < .001), during cervical preparation, but were more likely to require oxytocin IOL (88 Vs 59%, p = .001). Conclusions OPC was feasible and acceptable for IOL of women with an unfavourable cervix at term compared to IP, however did not show a statistically significant reduction in total inpatient stay and was associated with increased oxytocin IOL. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN:12609000420246.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Adult / Ambulatory Care - methods / Ambulatory Care - statistics & numerical data / Australia / Biomedical aspects of pregnancy / Catheters / Cervical Ripening - drug effects / Cervix Uteri - drug effects / Cervix Uteri - physiology / Cesarean section / Comparative Effectiveness Research - methods / Dinoprostone - administration & dosage / Dinoprostone - adverse effects / Feasibility Studies / Female / Foley catheter / Gynecology / Hospitalization - statistics & numerical data / Humans / Induction of labour / Labor, Induced - instrumentation / Labor, Induced - methods / Maternal and Child Health / Mechanical ripening / Medical research / Medicine / Medicine & Public Health / Obstetrics / Oxytocics - administration & dosage / Oxytocics - adverse effects / Patient Acceptance of Health Care / Patient satisfaction / Patient Satisfaction - statistics & numerical data / Pregnancy / Prostaglandin / Randomised controlled trial / Reproductive Medicine / Research Article / Studies / Surveys and Questionnaires / Tertiary Care Centers / Treatment Outcome / Unfavourable cervix / Urinary Catheterization - adverse effects / Urinary Catheterization - methods / Uterine Cervical Incompetence - diagnosis / Uterine Cervical Incompetence - therapy / Womens health