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Cervical ripening as an outpatient procedure in the pandemic – minimizing the inpatient days and lowering the socioeconomic costs

  • Julia Kummer ORCID logo EMAIL logo , Josefine Theresia Koenigbauer , Yvonne Callister , Luisa Pech , Werner Rath , Silke Wegener and Lars Hellmeyer
Published/Copyright: August 9, 2022
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 50 Issue 9

Abstract

Objectives

With an increasing incidence of labor induction the socioeconomic costs are increasing and the burden on hospital capacities is rising. In addition, the worldwide SARS-CoV-2 pandemic asks for improvements in patient care during pregnancy and delivery while decreasing the patient-staff contact. Here, we are retrospectively analyzing and comparing a mechanical ripening device that is utilized as an outpatient procedure to misoprostol and dinoprostone as inpatient induction methods in a low risk cohort.

Methods

This is a retrospective comparative analysis of obstetric data on patients who presented for cervical ripening and labor induction. Ninety-six patients received a mechanical ripening agent as an outpatient procedure. As a control group, we used 99 patients with oral misoprostol (PGE1) and 42 patients with vaginal dinoprostone (PGE2) for cervical ripening in an inpatient setting. Data from 2016 until 2020 were analysed.

Results

Baseline characteristics showed no significant differences. Delivery modes were similar in all groups. The time period from patient admission to onset of labor was significantly shorter in the outpatient group (p<0.001): 10.9 h/0.5 days (±13.6/0.6) for osmotic dilator vs. 17.9 h/0.7 days (±13.1/0.5) for oral misoprostol vs. 21.8 h/0.8 days (±15.9/0.7) for vaginal dinoprostone. With 20.4 h/0.8 days (±14.3/0.6) the osmotic dilator group displayed significantly the shortest inpatient stay from admission to delivery (p=0.027). The patient subgroup of misoprostol had 25.7 h/1.1 days (±14.9/0.6) of inpatient stay from admission to delivery and the patient group of dinoprostone 27.5 h/1.1 days (±16.0/0.7). There were fewer hospital days in the outpatient group: 84.9 h/3.5 days vs. 88.9 h/3.7 days vs. 93.6 h/3.9 days (outpatient osmotic dilator vs. inpatient misoprostol and dinoprostone, respectively).

Conclusions

New approaches are required to decrease individual contacts between patients and staff while maintaining a high quality patient care in obstetrics. This analysis reveals that outpatient mechanical cervical ripening can be as safe and effective as inpatient cervical ripening with PGE1/PGE2, while lowering patient-staff contact and total hospital stays and therefore decreasing the socioeconomic costs.

Keywords: cervical ripening; Covid-19 pandemic; labor induction; osmotic dilator; outpatient care; socioeconomic costs in health care system
Corresponding author: Julia Kummer, Department of Gynecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Klinik für Gynäkologie und Geburtshilfe, Landsberger Allee, 49 10249 Berlin, Germany, E-mail:
Josefine Koenigbauer, Department of Gynecology and Obstetrics, Charité University Hospital, Berlin, Germany, E-Mail: josefine.koenigbauer@charite.de

  1. Research funding: None declared.

  2. Author contributions: Kummer, Julia – study design, statistical analysis, writing; Koenigbauer, Josefine Theresia – study design, writing; Callister, Yvonne – linguistic revision; Pech, Luisa – patient recruitment. Wegener, Silke – patient recruitment; Rath, Werner – senior consultant, study design. Hellmeyer, Lars – senior consultant. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study has been approved by the local Ethics Committee (Berlin medical chamber/ Ärztekammer Berlin).

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Received: 2022-04-20
Accepted: 2022-06-24
Published Online: 2022-08-09
Published in Print: 2022-11-25

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Obstetric hemorrhage: effective methods for addressing the menace in Sub-Saharan Africa
  4. Mini Review
  5. The use of neurally-adjusted ventilatory assist (NAVA) for infants with congenital diaphragmatic hernia (CDH)
  6. Opinion Paper
  7. The role of specialist perinatal psychiatrists in modern medicine
  8. Corner of Academy
  9. Maternal perception of fetal movements: onset and associated factors
  10. Original Articles – Obstetrics
  11. Cervical ripening as an outpatient procedure in the pandemic – minimizing the inpatient days and lowering the socioeconomic costs
  12. Can sonographic imaging of the fetal pancreas predict perinatal outcomes in gestational diabetes mellitus?
  13. Comparison of transvaginal sonographic cervical length measurement and Bishop score for predicting labour induction outcomes
  14. Regional differences in utilization of 17α-hydroxyprogesterone caproate (17-OHP)
  15. Effect of anesthesia selection on neonatal outcomes in cesarean hysterectomies for placenta accreta spectrum (PAS)
  16. Bile-acid levels and lung maturity test in patients with intrahepatic cholestasis of pregnancy
  17. Evaluation of appropriate vancomycin prescribing for the prevention of newborn group B streptococcal infections in a community hospital obstetrics service
  18. Effect of supplementation with 5,000 IU of vitamin D on the glycemic profile of women with gestational diabetes mellitus
  19. Association of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms with vitamin B12 deficiency and adverse perinatal outcomes among pregnant women of rural South India – a cross sectional longitudinal study
  20. Original Article – Fetus
  21. Fetal autopsy for the diagnosis of skeletal dysplasia and comparison with prenatal ultrasound findings over a 16-year period
  22. Original Articles – Neonates
  23. Neonatal admission rate after vaginal breech delivery
  24. Extremely low gestational age neonates and resuscitation: survey on perspectives of Canadian neonatologists
  25. The effect of 150 and 80 mg doses of aspirin on preventing preterm birth in high-risk pregnant women
  26. Letters to the Editor
  27. Aspirin for the prevention of preeclampsia
  28. Reply to: Aspirin for the prevention of preeclampsia
  29. Total bile acid levels for clinically suspected intrahepatic cholestasis of pregnancy
  30. Reply: Neonatal lung injury with intrahepatic cholestasis of pregnancy
  31. Marijuana and pregnancy: just because its legal doesn’t make it safe
  32. Corrigenda
  33. Stillbirth aftercare in a tertiary obstetric center–parents’ experiences
  34. Prospective risk of stillbirth according to fetal size at term
https://doi.org/10.1515/jpm-2022-0196
Keywords for this article
cervical ripening; Covid-19 pandemic; labor induction; osmotic dilator; outpatient care; socioeconomic costs in health care system

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Obstetric hemorrhage: effective methods for addressing the menace in Sub-Saharan Africa
  4. Mini Review
  5. The use of neurally-adjusted ventilatory assist (NAVA) for infants with congenital diaphragmatic hernia (CDH)
  6. Opinion Paper
  7. The role of specialist perinatal psychiatrists in modern medicine
  8. Corner of Academy
  9. Maternal perception of fetal movements: onset and associated factors
  10. Original Articles – Obstetrics
  11. Cervical ripening as an outpatient procedure in the pandemic – minimizing the inpatient days and lowering the socioeconomic costs
  12. Can sonographic imaging of the fetal pancreas predict perinatal outcomes in gestational diabetes mellitus?
  13. Comparison of transvaginal sonographic cervical length measurement and Bishop score for predicting labour induction outcomes
  14. Regional differences in utilization of 17α-hydroxyprogesterone caproate (17-OHP)
  15. Effect of anesthesia selection on neonatal outcomes in cesarean hysterectomies for placenta accreta spectrum (PAS)
  16. Bile-acid levels and lung maturity test in patients with intrahepatic cholestasis of pregnancy
  17. Evaluation of appropriate vancomycin prescribing for the prevention of newborn group B streptococcal infections in a community hospital obstetrics service
  18. Effect of supplementation with 5,000 IU of vitamin D on the glycemic profile of women with gestational diabetes mellitus
  19. Association of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms with vitamin B12 deficiency and adverse perinatal outcomes among pregnant women of rural South India – a cross sectional longitudinal study
  20. Original Article – Fetus
  21. Fetal autopsy for the diagnosis of skeletal dysplasia and comparison with prenatal ultrasound findings over a 16-year period
  22. Original Articles – Neonates
  23. Neonatal admission rate after vaginal breech delivery
  24. Extremely low gestational age neonates and resuscitation: survey on perspectives of Canadian neonatologists
  25. The effect of 150 and 80 mg doses of aspirin on preventing preterm birth in high-risk pregnant women
  26. Letters to the Editor
  27. Aspirin for the prevention of preeclampsia
  28. Reply to: Aspirin for the prevention of preeclampsia
  29. Total bile acid levels for clinically suspected intrahepatic cholestasis of pregnancy
  30. Reply: Neonatal lung injury with intrahepatic cholestasis of pregnancy
  31. Marijuana and pregnancy: just because its legal doesn’t make it safe
  32. Corrigenda
  33. Stillbirth aftercare in a tertiary obstetric center–parents’ experiences
  34. Prospective risk of stillbirth according to fetal size at term
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