Implementation of an outpatient cervical ripening initiative: Outcomes and patient & provider perspectives

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Objective: To examine implementation and patient/provider acceptance of an outpatient mechanical cervical ripening program for labor induction with the goal of reducing length of stay on Labor & Delivery (L&D).

Study design: Initially, outpatient cervical ripening was "available", and later (due to low utilization) "mandatory" for eligible patients induced Monday-Friday, with weekend induction available for those declining outpatient ripening. Single-balloon catheters were used, with supplemental vaginal misoprostol for inpatients. Utilization was compared for two 3-month periods (pre- and post-mandatory phases). Patient and provider surveys queried perceived benefits, risks, barriers, pain, likelihood to recommend, and satisfaction. Outcomes (length of stay in L&D, delivery mode, chorioamnionitis, hemorrhage, and NICU admission) were compared between the inpatient and outpatient groups.

Results: Outpatient ripening among eligible patients increased from 13.5% to 55.1% after becoming mandatory (p

Conclusion: Outpatient cervical ripening utilization was minimal until it became mandatory. Providers were overall satisfied. Balloon placement location did not affect patient satisfaction. Among patients undergoing mechanical ripening, those receiving an outpatient balloon had a 4-hour decreased L&D length of stay. There were no differences in delivery outcomes.

Type

Article

PubMed ID

41135588

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