Outpatient Foley catheter versus inpatient prostaglandin E2 gel for induction of labour: a randomised trial

Women with an unfavourable cervix requiring IOL at term (N？=？101) were randomised to outpatient care using Foley catheter (OPC, n？=？50) or inpatient care using vaginal PGE2 (IP, n？=？51). OPC group had Foley catheter inserted and were discharged overnight following a reassuring cardiotocograph. IP group received 2？mg/1？mg vaginal PGE2 if nulliparous or 1？mg/1？mg if multiparous. Main outcome measures were inpatient stay (prior to birth, in Birthing Unit, total), mode of birth, induction to delivery interval, adverse reactions and patient satisfaction.OPC group had shorter hospital stay prior to birth (21.3 vs. 32.4？hrs, p？<？.001), IP were more likely to achieve vaginal birth within 12？hours of presenting to Birthing Unit (53% vs. 28%, p？=？.01). Vaginal birth rates (66% OPC Vs. 71% IP), total induction to delivery time (33.5？hrs vs. 31.3？hrs) and total inpatient times (96？hrs OPC Vs. 105？hrs IP) were similar. OPC group felt less pain (significant discomfort 26% Vs 58%, p？=？.003), and had more sleep (5.8 Vs 3.4？hours, p？<？.001), during cervical preparation, but were more likely to require oxytocin IOL (88 Vs 59%, p？=？.001).OPC was feasible and acceptable for IOL of women with an unfavourable cervix at term compared to IP, however did not show a statistically significant reduction in total inpatient stay and was associated with increased oxytocin IOL.Australian New Zealand Clinical Trials Registry, ACTRN:12609000420246.Induction of labour (IOL) is one of the commonest obstetric interventions, occurring in approximately 25% of term pregnancies in developed countries [1]. For women with an unfavourable cervix requiring IOL, cervical preparation is usually recommended, as oxytocin use alone leads to a longer induction to delivery interval and possibly increased intervention [2]. Both chemical and mechanical methods for cervical preparation are available, with prostaglandin preparations (PGE1 and PGE2) used as the chemical method, and variations of intracervical catheter (ei