Outpatient cervical ripening

Induction of labor is one of the most commonly performed obstetric procedures. Many patients undergoing labor induction require cervical ripening. In an era where cost and patient satisfaction have become paramount, the idea of outpatient cervical ripening is appealing; provided it can be performed in a safe and cost effective manner. The ideal agent would induce adequate cervical ripening without causing significant uterine contractions/labor. Various methods have been studied including administration of misoprostol, PGE2, nitric oxide donors, use of Foley balloon catheters and acupuncture. Each method has its strengths and limitations; however, larger studies of outpatient cervical ripening that are specifically powered for rare adverse maternal and fetal outcomes are needed before definitive recommendations can be made.