Contents: Original Research

Home Cervical Ripening With Dinoprostone Gel in Nulliparous Women With Singleton Pregnancies

Stock, Sarah J. PhD; Taylor, Rebecca MBChB; Mairs, Rebecca MBChB; Azaghdani, Abdulhamid MBChB; Hor, Kahyee MBChB; Smith, Imogen MBChB; Dundas, Kirsty MBChB; Kissack, Chris MBChB; Norman, Jane E. MD; Denison, Fiona MD

Author Information

Tommy's Centre for Maternal and Fetal Health and MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, and the Departments of Obstetrics and Gynaecology and Neonatology, Simpson Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, United Kingdom.

Corresponding author: Sarah J. Stock, PhD, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Little France, Edinburgh EH16 4TJ, U.K.; e-mail: [email protected].

Supported by Tommy's (registered charity Nos. 1060508 and SCO39280). Tommy's had no involvement in study design, data collection, analysis, interpretation, or writing of the report or the decision to publish.

Allyn Dick provided data from the maternity database systems and Vivek Varadarajan assisted with data formatting.

Presented at the Perinatal Medicine 2014 Conference, June 9–11, 2014, Harrogate, United Kingdom.

Financial Disclosure Dr. Dundas received funding from Ferring Pharmaceuticals to attend an educational course. Dr. Norman has received funding from charities and government bodies for investigating pregnancy problems, including the effects of induction of labor. She has received drug donations or partial donation of tests for noncommercially funded clinical trials. The other authors did not report any potential conflicts of interest.

Obstetrics & Gynecology 124(2 PART 1):p 354-360, August 2014. | DOI: 10.1097/AOG.0000000000000394

OBJECTIVE: 

To evaluate whether home cervical ripening is safe and results in shorter hospital stay.

METHODS: 

This was a retrospective cohort study of women with singleton pregnancies having induction of labor for postmaturity at a single center between January 2007 and June 2010. Women were offered home cervical ripening with 1 mg dinoprostone gel if they were nulliparous, had uncomplicated singleton pregnancies, and the indication for induction was postmaturity.

RESULTS: 

Nine hundred seven of 1,536 (59.1%) nulliparous women having induction of labor for postmaturity were eligible for home cervical ripening. The median number of hours at home was 11.76 hours (range 0–24.82 hours). There were no cases of birth outside of the hospital, uterine rupture, or significant neonatal morbidity or neonatal death related to home cervical ripening. Eighty-five (5.5%) women who underwent hospital cervical ripening because of maternal preference or social issues formed a hospital cervical ripening comparison group. There was no significant difference in the total number of hours before delivery spent in the hospital between the two groups (26.25; 95% confidence interval [CI] 25.27–27.23 in home cervical ripening group compared with 24.28; 95% CI 22.5–26.0 in the hospital group; P=.26).

CONCLUSIONS: 

Clinical outcomes are comparable in nulliparous women who receive a single dose of dinoprostone gel for home cervical ripening compared with those who undergo hospital cervical ripening. However, preadmission home cervical ripening with 1 mg dinoprostone does not decrease the number of hours women spend in the hospital.

LEVEL OF EVIDENCE: 

II

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

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