Abstract
Objective
This study aimed to describe patient characteristics, satisfaction, and outcome measures
for patients undergoing outpatient cervical ripening.
Study Design
A retrospective cohort study using electronic health record data from March 2020 to
March 2022 from a large health system. The sample included patients with a low-risk
singleton pregnancy undergoing outpatient cervical ripening with either an osmotic
dilator or Foley balloon catheter. A subset of patients completed satisfaction surveys.
Frequencies and means were used to describe the population and conduct comparisons
by device type. Inverse probability of treatment weighted estimates were generated
to address baseline differences between patients in the two device groups.
Results
Outpatient cervical ripening was completed by 120 patients (80 osmotic dilators and
40 Foley balloon catheters). The mean time from insertion to inpatient admission was
16.2 ± 4.8 hours. The mean change in simplified Bishop score (SBS) was 1.8 ± 1.4 and
the mean change in dilation was 1.8 ± 1.1 cm. There were no differences in the amount
of cervical change by device type. Patients returned earlier than planned 16.7% of
the time, primarily for contractions or rupture of membranes. Following outpatient
cervical ripening, the time from admission to delivery was 19.9 ± 10.3 hours, with
no difference by device type. Vaginal delivery occurred for 74.8% of patients. Patients
reported overall satisfaction with the outpatient cervical ripening experience, with
the highest satisfaction among those with osmotic dilators. Patients with both device
types stated they would recommend outpatient cervical ripening to others, and experienced
low levels of stress and discomfort at home prior to hospital admission.
Conclusion
Patients participating in outpatient cervical ripening with osmotic dilators or Foley
balloon catheters experienced clinically meaningful changes in dilation and SBSs while
at home and reported general satisfaction with the outpatient program experience.
Key Points
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Outpatient use of osmotic dilators or Foley balloon catheters improved Bishop scores.
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Patient and device complications were comparable to other research findings.
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Patients reported overall satisfaction with outpatient cervical ripening.
Keywords
cervical ripening - induction - Foley balloon - Dilapan-S - osmotic dilator - outpatient
