Home Labour Induction with Retrievable Prostaglandin Pessary and Continuous Telemetric Trans-Abdominal Fetal ECG Monitoring

Abstract

ObjectiveTo evaluate the feasibility of continuous telemetric trans-abdominal fetal electrocardiogram (a-fECG) in women undergoing labour induction at home.Study DesignLow risk women with singleton term pregnancy undergoing labour induction with retrievable, slow-release dinoprostone pessaries (n = 70) were allowed home for up to 24 hours, while a-fECG and uterine activity were monitored in hospital via wireless technology. Semi-structured diaries were analysed using a combined descriptive and interpretive approach.Results62/70 women (89%) had successful home monitoring; 8 women (11%) were recalled because of signal loss. Home monitoring lasted between 2–22 hours (median 10 hours). Good quality signal was achieved most of the time (86%, SD 10%). 3 women were recalled back to hospital for suspicious a-fECG. In 2 cases suspicious a-fECG persisted, requiring Caesarean section after recall to hospital. 48/51 women who returned the diary coped well (94%); 46/51 were satisfied with home monitoring (90%).ConclusionsContinuous telemetric trans-abdominal fetal ECG monitoring of ambulatory women undergoing labour induction is feasible and acceptable to women.

Women's experiences of cervical ripening as inpatients on an antenatal ward

“…Previous studies exploring women's experiences of outpatient cervical ripening or induction reported that women identified the ongoing support and presence of family members at home as comforting and beneficial [7,8,10]. Reported anxieties by participants in our study are therefore unsurprising.…”

“…Engagement with the research data revealed a strong sense that participants' experiences of the cervical ripening procedure were "undermined" in relation to the 4 overarching themes identified. Although women's dissatisfaction with labour induction [11][12][13]15] and increased satisfaction with outpatient cervical ripening [3,[6][7][8][9][10] have been previously reported in other studies, the notion of women's experiences being undermined during inpatient cervical ripening has not previously been identified in the literature reviewed. This may be due to the fact that there is a dearth of previous enquiry exploring women's experiences of inpatient cervical ripening.…”

“…Clinical trials have focused on clinical outcomes, and/or the nature of the procedure, which have been the main focus of the debate over the setting for cervical ripening, with only a few of these studies reporting on maternal satisfaction as a secondary outcome [3,5,6]. Previous studies exploring women's experiences of cervical ripening have been in relation to clinical trials, thus the care participants received was not usual care, but rather care guided by a research protocol [7][8][9][10]. Furthermore, previous studies have been undertaken regarding women's views and experiences of the entire process of labour induction in the context of usual care [11][12][13][14][15], but none to date have focused on women's experiences of cervical ripening as inpatients.…”

“…Both studies also included an evaluation of maternal satisfaction, reporting increased satisfaction in the outpatient groups. Rauf et al [10] reported on women's experiences of outpatient cervical ripening with remote fetal monitoring, whilst O'Brien et al [7] further explored participants' experiences from the study by Rauf et al [10] using a qualitative approach. Similarly, using a survey technique and a qualitative approach respectively, Turnbull et al [9] and Oster et al [8] explored the satisfaction and experiences of participants who took part in an ongoing RCT exploring inpatient versus outpatient cervical ripening [9].…”

“…Similarly, using a survey technique and a qualitative approach respectively, Turnbull et al [9] and Oster et al [8] explored the satisfaction and experiences of participants who took part in an ongoing RCT exploring inpatient versus outpatient cervical ripening [9]. Findings from these studies were that women reported less pain and anxiety, comfort from significant others and a shorter stay in hospital with outpatient cervical ripening [3,[5][6][7][8][9][10].…”