October 17th, 2017

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Title:
Outpatient Preinduction Cervical Ripening Using a Balloon Catheter: A Meta-Analysis
Authors:  Daniel Weinberg, M.D., Nathan Blue, M.D., Bradley Holbrook, M.D., and William Rayburn, M.D., M.B.A.
  OBJECTIVE: To assess the literature comparing outpatient versus inpatient preinduction cervical ripening using a balloon catheter.

STUDY DESIGN: Using various terms and combinations, we searched the literature for trials of outpatient cervical ripening with a balloon catheter. Inclusion criteria were a full-text, English language publication; randomized controlled study design; no intrauterine growth restriction; gestational age of ≥37 weeks; intact membranes; reassuring fetal heart rate pattern; and initial Bishop score <7. Outcomes that were reported in at least 2 trials were analyzed.

RESULTS: We identified 3 trials for inclusion with 260 study subjects, of which 144 were randomized to outpatient ripening. Study designs and inclusion criteria were similar between the 3 studies. The outpatient group spent less time in the hospital before delivery (17.0 vs. 27.6 hours, p<0.001) but required a longer period of oxytocin when necessary (11.1 vs. 9.2 hours, p<0.001). There were no differences in catheter placement to delivery time, epidural use, uterine tachysystole, fever, mode of delivery, postpartum hemorrhage, 5-minute Apgar scores, or nursery admission.

CONCLUSION: Outpatient preinduction cervical ripening with a balloon catheter shortens the hospital time to delivery and appears to be an acceptable alternative for low-risk pregnancies at term.
Keywords:  balloon catheter; cervical ripening; induction of labor; metaanalysis; outpatient
   
   
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