Outpatient Versus Inpatient Induction of Labour With Oral Misoprostol: A Multicentre Randomised-Controlled Trial

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Induction of labour (IOL) is a common obstetric procedure.
• Evaluating outpatient versus inpatient settings for IOL is crucial for optimizing maternal care and resource utilization.
• Oral misoprostol is an established agent for cervical ripening and IOL.

Purpose of the Study:

• To compare childbirth satisfaction and obstetrical outcomes between outpatient and inpatient induction of labour (IOL).
• To assess the feasibility and maternal experience of outpatient IOL.
• To identify potential benefits, such as reduced hospital stay and cost-effectiveness.

Main Methods:

• A multicentre, randomized-controlled trial was conducted across eight hospitals in Norway.
• Low-risk women scheduled for IOL, with single cephalic presentation and no previous uterine scar, were included.
• Oral misoprostol (25 μg) was administered for up to 48 hours as the primary induction agent, with childbirth satisfaction assessed using the Childbirth Experience Questionnaire (CEQ) and Experience with Induction Tool (EXIT).

Main Results:

• Outpatient IOL led to a more positive childbirth experience (mean CEQ-score 3.1 vs. 3.0, p=0.02).
• Women in the outpatient group had a significantly shorter hospital admission duration (15 vs. 36 hours, p<0.01).
• Obstetrical outcomes were similar between groups, with no reported cases of hyperstimulation before labour or serious adverse events.

Conclusions:

• Outpatient IOL with oral misoprostol is associated with high maternal satisfaction and a preference for future pregnancies (89%).
• Labour outcomes are comparable to inpatient induction, suggesting outpatient management is a safe and effective alternative.
• This approach offers potential cost benefits due to reduced hospital admission and is advocated as a feasible option for appropriately selected women, warranting further investigation for rare adverse events.