Inpatient Versus Outpatient Labor Induction: A Systematic Review and Meta-analysis [19F]
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INTRODUCTION:The purpose of this study was to compare clinical and cost outcomes between inpatient and outpatient labor induction.METHODS:A systematic review of randomized controlled trials (RCTs) that compared inpatient vs. outpatient induction was conducted. Four databases were searched for RCTs published in English, which compared any method of outpatient vs. inpatient labor induction. As significant heterogeneity between studies was anticipated, random-effects meta-analysis was conducted. Results were presented as odds ratios (OR) and mean difference (MD) with 95% confidence intervals (95% CI) as appropriate.RESULTS:We identified 695 studies of which 10 representing 7 RCTs (2038 patients) conducted in Australia (n=3), Canada, Portugal, the Netherlands and United States were included in the final analysis. Three RCTs compared induction using balloon catheters, two compared prostaglandins, one compared balloon catheters (outpatient) vs. prostaglandin (inpatient) and one compared outpatient amniotomy vs. inpatient induction using the obstetricians' method of choice. Outpatient vs. inpatient induction was associated with a significant reduction in admission-to-delivery duration [2 studies, 231 patients: MD 11.78 hours (7.09, 16.49)]. There was no difference in use of epidural analgesia [4 studies, 475/863 vs. 454/832, OR 1.04 (0.84, 1.27)], oxytocin [4 studies, 292/643 vs. 269/632, OR 1.143 (0.52, 2.52)], vaginal birth [5 studies, 392/708 vs. 388/697, OR 0.97 (0.70, 1.32)], hyperstimulation [4 studies, 12/643 vs. 9/632, OR 1.27 (0.52, 3.11)] or costs [MD $80.21 (-638.20, 798.61)].CONCLUSION:Outpatient labor induction is associated with shorter admission-to-delivery duration, with no significant differences in adverse clinical or cost outcomes and may therefore be considered as an alternative to inpatient IOL in low-risk pregnancies.
