Outpatience induction: is it feasible?

Although there has been a constant steady increase in the rates of induction of labour in Europe and North America as from the 1980s, it may be complicated by prolonged labour and increased incidence of operative delivery, especially in the presence of an unfavourable cervix. However, it has been demonstrated that such complications may be reduced if the condition of the cervix has been improved with pharmacological and/or mechanical ripening agents, Moreover, as an increasingly important aspect of labour induction is patient satisfaction, outpatient cervical ripening is becoming a diffuse practice in selected low risk post-term pregnancies. The available evidence on outpatient cervical ripening safety and efficacy is based on 2 Randomized Controlled Trials comparing inpatient vs outpatient cervical ripening. One study used the controlled release of prostaglandin E2 and the other, transcervical Foley in uncomplicated pregnancies at term with a Bishop score of < 5/6. Although these studies suggest that inpatient and outpatient induction achieve comparable maternal and fetal outcomes, outpatient cervical ripening not only reduces hospitalisation times, but also improves patient satisfaction as to the induction of labour. The National Institute for Health and Clinical Excellence guidelines recommend that, in an outpatient setting, induction should only be carried out if safety and support procedures are in place and that this practice be audited continuously. Further studies are required to further asses the safety and clinical/cost efficacy of outpatient vs inpatient induction.