Outpatient Cervical Ripening With a Balloon Catheter: Systematic Review and Meta-analysis [38B]. (May 2020)

• Record Type: Journal Article
• Authors: Pierce-Williams, Rebecca; Harper, Lorie; Kuper, Spencer; Sciscione, Anthony; Berghella, Vincenzo; Lesser, Henry
• Is Part Of: Obstetrics and gynecology. Volume 135(2020)Supplement 1
• Publication Date: 2020-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000663228.79699.94
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: To evaluate the difference in time on Labor and Delivery with outpatient versus inpatient cervical ripening with a balloon catheter in low-risk women. METHODS: This was a systematic review and meta-analysis including only randomized controlled trials (RCTs). Electronic databases (PubMed, Scopus, and Cochrane Central Register of Controlled Trials) were searched for eligible articles from inception to July 2019. Those not comparing balloon use in both arms of the RCT were excluded. The reference lists of identified articles were examined to identify additional studies. RESULTS: Four RCTs, including 418 women, met inclusion criteria. Only one RCT directly compared balloon only cervical ripening in the two arms. Two RCT protocols allowed for use of prostaglandins after the balloon if amniotomy was unacceptable or for Bishop score <6. In one RCT, oxytocin was administered to the inpatient arm. The mean difference in time on Labor and Delivery when comparing the outpatient to inpatient groups was -5.39 hours (95% confidence interval (CI) -7.14 to -3.64). Among three studies with available data, there was no difference in duration of oxytocin use (mean difference 1.17 hours, 95% CI -0.16 to 2.50). The outpatient group was significantly more likely to deliver vaginally than the inpatient group (Odds Ratio 2.1, 95% CI 1.31 to 3.37). CONCLUSION: Based on this analysis, outpatient cervical ripening with a balloon catheter in low-risk women is associated with a decreased amount of time spent on Labor and Delivery and increased rates of vaginal birth. This will likely translate into decreased hospital costs and improved patient outcomes.