Outpatient Versus Inpatient Induction of Labour With Oral Misoprostol: A Multicentre Randomised-Controlled Trial

Objective

To compare childbirth satisfaction and obstetrical outcomes with outpatient versus inpatient induction of labour (IOL).

Design

Multicentre, randomised-controlled trial.

Setting

Eight hospitals in Norway.

Population

Women scheduled for IOL, single cephalic presentation, ≥ 37 weeks, no previous uterine scar, and low risk of complications by predefined criteria.

Methods

Included women received oral misoprostol (25 μg) for up to 48 h as the primary induction agent. The Childbirth Experience Questionnaire (CEQ) and the Experience with Induction Tool (EXIT) were used to assess childbirth satisfaction.

Main Outcome Measures

CEQ-score.

Secondary Outcome Measures

EXIT questionnaire and obstetrical outcomes.

Results

Of 283 women randomised, 152 women were allocated to outpatient and 131 to inpatient settings. Outpatient IOL resulted in a more positive childbirth experience (mean CEQ-score 3.1 [0.44] vs. 3.0 [0.45]), mean difference 0.14, 95% CI (0.02–0.25), p = 0.02. In the outpatient group, women were admitted to the hospital 21 h shorter before delivery (15 vs. 36 h, mean difference −21, 95% CI −25 to −17, p < 0.01). Obstetrical outcomes were similar, and there were no cases of hyperstimulation before labour or serious adverse events.

Conclusion

Outpatient IOL using oral misoprostol was associated with high maternal satisfaction, with 89% of women expressing a preference for this method in future pregnancies. Labour outcomes appear comparable to those of inpatient induction, while outpatient management also provides potential cost benefits due to shorter hospital admission. We advocate for this method as a feasible option for appropriately selected women; however, the occurrence of rare adverse events necessitates further investigation through larger studies.

Trial Registration

ID NCT05144048. https://clinicaltrials.gov/study/NCT05144048?locStr=Norway&country=Norway&cond=Induction%20of%20Labor&rank=1