With one in four pregnancies undergoing induction of labor, and about half of those having an unfavorable cervix requiring cervical ripening, interest in performing cervical ripening on an outpatient basis to potentially reduce hospitalization time, decrease labor and delivery staffing, and improve patient satisfaction has grown.
This morning’s Samuel A. Cosgrove Memorial Lecture, “Is There a Place for Outpatient Pre-Induction Cervical Ripening at Term?” starts at 9:25 am in Ballroom ABC.
Anthony C. Sciscione, DO, Christiana Care Health Services, Newark, DE, will argue in favor of outpatient cervical ripening. Supporters of outpatient cervical ripening say that it offers many advantages.
William F. Rayburn, MD, MBA, University of New Mexico, Albuquerque, NM, will question the value of outpatient cervical ripening except in well-delineated situations with valid indications. A lack of large-scale reported experience in the literature means physicians don’t have the complete picture as to excluding excess risk. A pragmatic solution would be to gather observational data from large cohorts with robust surrogate outcomes. So far, study experience has involved term pregnancies of living fetuses with some means of continuous monitoring of uterine activity and the fetal heart rate for the first few hours. But the experience comparing both different drug therapies and mechanical cervical ripening have been limited in patient enrollments per study and the total enrollments of studies.
Both agree that the evidence so far suggests that outpatient cervical ripening appears to be safe in this low-risk population. Most studies, whether placebo-controlled or not, had adequate randomization with low levels of attrition. Compared with placebo, PGE2 (vaginal or intracervical) and misoprostol (oral or vagina) are effective. Also, reported benefits appear to be greater with outpatient balloon catheter placement.