Outpatient induction of labour with prostaglandins: Safety, effectiveness and women’s views

Abstract

Background: Nearly 28% of women underwent induction of labour in England in 2015-16. Women frequently report delays and poor experiences, and the process can put additional pressure on to busy labour wards. Outpatient induction of labour (OPIOL) enables women to return home to await the onset of contractions.

Aim: This literature review aims to explore the current research evidence base about OPIOL using prostaglandins and to identify gaps in the evidence base. Outcomes will be compared with those induced as inpatients.

Method: An electronic search was conducted to identify relevant quantitative and qualitative studies using keywords’. Once the final studies had been identified, a narrative synthesis of the findings was conducted.

Findings: Adverse outcomes were rare but the studies were not sufficiently powered to detect significant differences between outpatients and inpatients. There were some differences in cost and effectiveness between the included studies which may be explained by disparities in study design, participant characteristics and operational issues. Time avoided in hospital by outpatients ranged from 7.5 hours to 11.76 hours. Satisfaction was generally higher with OPIOL although some women expressed apprehension about being at home.

Conclusion: While OPIOL with prostaglandins is acceptable to women, it is not clear whether there are significant differences in safety and effectiveness outcomes due to the low frequency of adverse perinatal events as well as methodological and quality issues of the included studies. There is a need for further UK research to compare outcomes, maternal experiences and cost effectiveness of OPIOL.

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Identifiers

ORCID for Lisa Kirsten Smith: orcid.org/0000-0003-0724-289X

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