Safety, effectiveness, womenʼs experience, and economic costs of outpatient induction in women with uncomplicated pregnancies: A systematic review and meta-analyses

Abstract

Background: Induction of labor is increasing worldwide, and some countries have started to introduce outpatient induction in low-risk women. Objectives: To assess current knowledge concerning the safety, efficacy, women's experience, and economic costs of outpatient induction compared with inpatient induction. Search strategy: Multiple databases were last searched on October 19, 2021. Studies were selected according to our pre-specified inclusion, selection, and exclusion criteria. Selection criteria: PICO; P—women with low-risk pregnancy planned for induction of labor. I—Outpatient induction C—Inpatient induction O—Outcomes according to the core outcome set for induction of labor (COSIOL). Data collection and analysis: Pooled in meta-analyses. The certainty of evidence was assessed using the GRADE system. Main results: The 20 included studies, including 7956 women, showed an overall low incidence of adverse events and indicated comparable results for inpatient and outpatient induction, but the studies were underpowered for safety-related outcomes. Women's experiences of outpatient induction were mostly positive. Based on three studies, the economic costs consequence is inconclusive. Conclusions: Due to early randomization, heterogenic study design, and underpowered studies regarding safety outcome, the certainty of evidence is very low. It is uncertain whether outpatient induction affects the risk for neonatal and maternal complications.