Outpatient labor induction—Exploring future potential by assessing eligibility in a historical cohort

• Published in: Acta obstetricia et gynecologica Scandinavica 2024-06, Vol.103 (6), p.1101-1111
• Main Authors: Marsdal, Kjersti Engen, Sørbye, Ingvil Krarup, Bernitz, Stine, Sve, Ranveig Elise T., Ask, Kristine, Lukasse, Mirjam
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory Care; Birth; Clinical decision making; Clinical outcomes; Cohort Studies; Female; Humans; Induced labor; induction of labor; Labor, Induced - methods; maternity care; misoprostol; Misoprostol - administration & dosage; Norway; obstetrics; Original; Outpatient care facilities; outpatient labor induction; Oxytocics - administration & dosage; Patient safety; Pregnancy; Side effects
• ISSN: 0001-6349; 1600-0412
• DOI: 10.1111/aogs.14799

Introduction Labor induction rates have increased over the last decades, and in many high‐income countries, more than one in four labors are induced. Outpatient management of labor induction has been suggested in low‐risk pregnancies to improve women's birth experiences while also promoting a more efficient use of healthcare resources. The primary aim of this paper was to assess the proportion of women in a historical cohort that would have been eligible for outpatient labor induction with oral misoprostol. Second, we wanted to report safety outcomes and assess efficacy outcomes for mothers and infants in pregnancies that met the criteria for outpatient care. Material and methods Criteria for outpatient labor induction with oral misoprostol were applied to a historical cohort of women with induction of labor at two Norwegian tertiary hospitals in the period January 1, through July 31, 2021. The criteria included low‐risk women with an unscarred uterus expecting a healthy, singleton baby in cephalic position at term. The primary outcome was the proportion of women eligible for outpatient labor induction. Secondary outcomes included reasons for ineligibility and, for eligible women, safety and efficacy outcomes. Results Overall, 29.7% of the 1320 women who underwent labor induction in a singleton term pregnancy met the criteria for outpatient labor induction. We identified two serious adverse events that potentially could have occurred outside the hospital if the women had received outpatient care. The mean duration from initiation of labor induction to administration of the last misoprostol was 22.4 h. One in 14 multiparous women gave birth within 3 h after the last misoprostol dose. Conclusions In this historical cohort, three in ten women met the criteria for outpatient management of labor induction with oral misoprostol. Serious adverse events were rare. The average time span from the initiation of labor induction to the last misoprostol was nearly 24 h. This suggests a potential for low‐risk women with an induced labor to spend a substantial period of time at home before labor onset. However, larger studies testing or evaluating labor induction with oral misoprostol as an outpatient procedure are needed to draw conclusions. In this historical cohort, three in ten women met the criteria for outpatient management of labor induction using oral misoprostol. This finding implies the possibility for low‐risk women undergoing induced labor with oral misoprosto