Outpatient Foley For Starting Induction of Labor at Term in Nulliparous Women

Outpatient Foley For Starting Induction of Labor at Term in Nulliparous Women: A Randomized-Controlled Study

The investigators are performing a randomized controlled trial investigating starting cervical ripening in the outpatient setting with a mechanical method, the transcervical Foley catheter. The objective of the study is to determine if outpatient compared to inpatient cervical ripening with a transcervical Foley catheter in nulliparous women undergoing induction shortens the time spent in labor and delivery (from the time of admission to the time of delivery).

Approximately 20-25% of pregnant women undergo an induction of labor, and a large percentage of these women require cervical ripening in order to "ready" the cervix for induction. In the setting of an unfavorable cervix, induction of labor with oxytocin alone can be associated with longer times to delivery, uterine tachysystole (uterine contractions that are too frequent), and increased rates of cesarean delivery.

Outpatient cervical ripening is an attractive option for both women and their physicians, as this allows for the potential to spend less time in the hospital and more time in the comforts of the patient's own home.

The investigators will conduct a randomized controlled trial comparing outpatient to inpatient cervical ripening using a transcervical Foley catheter. Women will be randomized to undergo inpatient or outpatient transcervical Foley catheter cervical ripening beyond their 39th week of gestation. Women and their infants will be followed until the time of their discharge from the hospital.

Inclusion Criteria:

• Age ≥ 18
• Nulliparous
• Singleton gestation
• Gestational age between 39+0 and 42+0 weeks
• Vertex presentation
• Modified Bishop score <5 and cervical dilation ≤ 2 cm
• No prior cesarean or prior uterine surgery
• Resides within 30 minutes of UAB Hospital
• Access to a telephone
• Reliable transportation

Exclusion Criteria:

• Unsuitable for outpatient cervical ripening (e.g., IUGR, oligohydramnios, polyhydramnios, gestational hypertension or preeclampsia, complex maternal disease, provider discretion). Patients with well controlled Class A or B DM or chronic hypertension will be eligible.
• Latex allergy
• Contraindication to induction of labor
• Evidence of labor
• Fetal demise
• Fetal anomaly
• Inability to give consent (e.g., inability to read or write)