Logistics for achieving delivery: A secondary analysis of the home induction randomised controlled trial

Abstract

Objective

This secondary analysis evaluates the logistics of achieving vaginal delivery following outpatient induction. This includes changes in Bishop score before and after cervical ripening, the need for additional ripening agents, time interval from induction to delivery, all of which provide invaluable information when developing an outpatient induction of labour service.

Study design

We randomised healthy nulliparous women with no significant medical history, who agreed to elective induction of labour at 39 weeks’ gestation, to one of three forms of initial cervical ripening at home: 12 h of Dilapan-S, 24 h of Dilapan-S, or 24 h of slow-release dinoprostone (Propess). Patients returned to the hospital after 12 or 24 h for either amniotomy or, if the cervix remained unripe, additional doses of Prostin. We present our experience with the development of a regulated protocol for outpatient induction of labour, as well as safety considerations, in order to assist those wishing to adopt such practice. Effectiveness of each induction agent, time to delivery, and length of hospital stay were assessed as part of this secondary analysis.

Results

A total of 180/271 (66%) of all nulliparous women were delivered within 48 h of induction commencing, and 254/271 (94%) delivered within 72 h, inclusive of the time period spent at home. Participants in the Propess group were more likely to require early readmission than in the Dilapan-S groups (45% vs 9%). Patients randomised to Dilapan-S 12 h and Dilapan-S 24 h were more likely to require additional Prostin prior to amniotomy being possible (65% vs 34%). Those who did not require additional ripening had very high vaginal delivery rates ranging from 80% to 88%. Induction agent removal time to delivery was similar across all groups. The length of hospital stay ranged from a median of 76 to 88 h from readmission to discharge.

Conclusion

Outpatient cervical ripening is an efficient and useful option for dealing with the logistical challenges facing busy Labour Wards, with the majority of nulliparous patients delivering within 48 h, including time spent at home. This resource-friendly option requires less time within the hospital setting for a carefully selected cohort.