Outpatient Cervical Ripening Safely Shortens Inpatient Labor

Researchers at Thomas Jefferson University (TJU; Philadelphia, PA, USA), The Women’s Hospital (Newburgh, IN, USA), and other institutions examined six studies involving 571 low-risk patients with singleton gestations (of at least 37 weeks) in order to evaluate whether outpatient cervical ripening with a balloon catheter results in a shorter amount of time in the labor and delivery unit, when compared with medical induction use in the inpatient setting.

The results revealed that the outpatient group had a mean 16.3 hours in the labor and delivery unit, as compared with 23.8 hours for the inpatient group, a difference of 7.24 hours. The researchers also observed a significant 24% decreased risk of cesarean delivery, and no stillbirths were reported. Demographically, body mass index (BMI) was lower in the outpatient group, with no differences in maternal age, gestational age at induction, or parity. The study was published on January 6, 2022, in Obstetrics & Gynecology.

“We knew induction was good in the hospital for many indications. We now know that induction can be started at home, and it's safe,” said corresponding author Vincenzo Berghella, MD, director of the maternal-fetal medicine at TJU. “The lower rate of cesarean delivery in the outpatient group likely reflected less use of fetal heart-rate monitoring, which can produce false-positive predictions of fetal compromise.”

Balloon catheters have been used for labor induction as far back as the 1890s. It has been postulated that the mechanical stretching by the catheter balloon causes an increased release of endogenous prostaglandins, which in turn cause cervical ripening, and without significant uterine contractions or systemic side effects in mothers. Expulsion of the balloon catheter usually occurs when a cervical dilation of about four cm is evident.

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Thomas Jefferson University
The Women’s Hospital