Outpatient induction -- how safe

There is a world-wide interest in outpatient care. Induction of labor is commonly offered to women with prolonged pregnancy, and evidence from randomized controlled studies suggest that inpatient and outpatient induction achieve comparative maternal and fetal outcomes. However, safety data are very limited. Careful selections of appropriate patients as well as standardized monitoring protocols are essential before outpatient induction can be initiated. Uterine hyperstimulation with fetal heart rate deceleration and other maternal or fetal adverse events are rare but unpredictable. Unrecognized fetal hypoxia due to uterine contractions remains an unsolved problem after discharge from the hospital. The ideal method for outpatient cervical ripening is controversial. The local application of nitric oxide donors prior to induction might be a promising approach. Larger studies are necessary before widespread use of outpatient cervical ripening by prostaglandins or other cervical ripening agents can be advocated.