BackgroundInduction of labour (IOL) is one of the commonest obstetric interventions, with significant impact on both the individual woman and health service delivery. Outpatient IOL is an attractive option to reduce these impacts. To date there is little data comparing outpatient and inpatient IOL methods, and potential safety concerns (hyperstimulation) if prostaglandins, the standard inpatient IOL medications, are used in the outpatient setting. The purpose of this study was to assess feasibility, clinical effectiveness and patient acceptability of outpatient Foley catheter (OPC) vs. inpatient vaginal PGE2 (IP) for induction of labour (IOL) at term.MethodsWomen 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.ResultsOPC 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).ConclusionsOPC 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.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN:12609000420246.

No abstract

OFC had fewer inpatient hours and costs prior to birth. However, OFC did not reduce overall inpatient hours and failed to achieve comparable rates of vaginal delivery within 12 h of birthing unit admission. Therefore, OFC is unlikely to be considered cost-effective compared to IPG in current hospital settings.

Background Little is known about the pregnancy outcomes of women who have had a stroke prior to a first pregnancy. Aim To identify a cohort of primiparous women giving birth to a single baby and compare the pregnancy outcomes of those with a pre‐pregnancy stroke hospitalisation record to those without a stroke hospitalisation record. Materials and Methods Record linkage study of all primiparous women aged 15–44 years with singleton pregnancies birthing in New South Wales, Australia from 2003 to 2015. Stroke was identified from 2001 to 2015 hospital data using International Classification of Diseases tenth Edition – Australian Modification codes I60–64. Women whose first hospital record of stroke was during pregnancy or <42 days after birth were excluded. Outcomes included diabetes or hypertension during pregnancy, mode of delivery, haemorrhage, severe maternal morbidity (validated composite outcome indicator), gestational age at birth, Apgar score (1 min < 7), and small‐for‐gestational age. Results Of 487 767 women with a first pregnancy, 124 (2.5/10 000) had a hospital record which included a pre‐pregnancy stroke diagnosis. Women with a stroke history were more likely to have an early‐term delivery (37–38 weeks; relative risk (RR) 1.49, 95% CI 1.17–1.90) and a pre‐labour caesarean (RR 2.83, 95% CI 2.20–3.63). There were no significant differences in other maternal or neonatal outcomes. Conclusion This is the largest reported study of pregnancy and birth outcomes for women with a history of stroke. With the exception of pre‐labour caesarean, there were no differences in pregnancy outcomes for women with a history of stroke compared with women with no history of stroke.