Vaginal misoprostol for cervical ripening at term: comparison of outpatient vs. inpatient administration

To compare outpatient with inpatient misoprostol for preinduction cervical ripening at term.

This concurrent cohort study was conducted between August 1999 and July 2002 at a rural community hospital. Pregnancies > or =38 weeks with an unfavorable cervix were eligible if there was a reactive nonstress test with no regular contractions or active medical/obstetric complications. Outpatients were given a single dose of misoprostol (50 microg intravaginally). A cohort group consisted of similar patients undergoing misoprostol therapy in the hospital.

No differences were found between the outpatient (n=177) and inpatient (n=96) misoprostol groups for maternal age, parity, gestational age, and initial cervical dilation and station. No home deliveries occurred with outpatient therapy. Advanced cervical dilation at hospital admission the next morning was more common with outpatient misoprostol (10.2% vs. 2.1%; RR 5.0, 95% CI 1.2, 21.5). Differences in mean times from admission to vaginal delivery were significantly shorter with outpatient than inpatient misoprostol (nulliparas, 3.1 hours, 95% CI 1.5, 4.7; multiparas, 5.3 hours; 95% CI 3.8, 6.8). The very low proportions of fetal intolerance to labor, low Apgar scores and newborn complications were not different between the 2 groups.

Outpatient vaginal misoprostol in a selected population led to more advanced cervical dilation at hospital admission the next morning and explained the shorter time until vaginal delivery.