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Outpatient Cervical Ripening with Balloon Catheters: A Systematic Review and Meta-analysis.

Rebecca Pierce-Williams1, Henry Lesser, Gabriele Saccone

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; the Department of Obstetrics and Gynecology and the Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Sinai Hospital, Baltimore, Maryland; the Department of Neuroscience, Reproductive Sciences & Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; the Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Obstetrics & Gynaecology (RWH), University of Melbourne, Melbourne, Australia; the Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, Delaware; and Tri-State Perinatology at the Women's Hospital, Newburgh, Indiana.

Obstetrics and Gynecology
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PubMed
Summary

Outpatient cervical ripening with balloon catheters significantly reduces labor and delivery unit time for low-risk patients. This method is a safe alternative, decreasing cesarean delivery rates and benefiting patients and units.

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Area of Science:

  • Obstetrics and Gynecology
  • Reproductive Medicine
  • Clinical Trials Research

Background:

  • Cervical ripening is a common procedure to initiate labor.
  • Balloon catheters are a widely used method for cervical ripening.
  • The setting (outpatient vs. inpatient) for balloon catheter use may impact patient outcomes and resource utilization.

Purpose of the Study:

  • To compare the duration of labor and delivery unit stay for patients undergoing outpatient versus inpatient cervical ripening with balloon catheters.
  • To evaluate secondary maternal and neonatal outcomes associated with each setting.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted.
  • Searches were performed across major databases (PubMed, Scopus, Cochrane Library, ClinicalTrials.gov) up to December 2020.
  • Eight RCTs involving 740 patients were included, with six studies reporting on the primary outcome.

Main Results:

  • Outpatient balloon cervical ripening was associated with a significant reduction in time spent in the labor and delivery unit (mean difference -7.24 hours).
  • The rate of cesarean delivery was lower in the outpatient group (21% vs. 27%; RR 0.76).
  • No significant differences were observed in total induction time, total hospital admission, or other maternal/neonatal outcomes.

Conclusions:

  • Outpatient balloon cervical ripening is a safe and effective alternative for low-risk patients.
  • This approach can decrease the length of stay in labor and delivery units.
  • Potential benefits include improved patient experience and optimized resource allocation for labor and delivery units.