To compare the efficacy and safety of cervical ripening with transcervical Foley catheter in inpatient vs outpatient setting

The aim of the current study is to compare the efficacy and safety of cervical ripening with transcervical Foley catheter in inpatient vs outpatient setting in a diverse, urban population within the United States. We hypothesize that there will be no differences in time-to-delivery, failed induction rates, cesarean section rates, or maternal/neonatal morbidity and that there will be no differences in total length of stay (LOS), hours of sleep, active labor duration, and perceived satisfaction between groups.

Inclusion Criteria:

• Indication for Induction of Labor is present
• Gestational age > 37 completed weeks with absence of comorbidities with an optimal dating (ultrasonography was performed before 22 weeks gestation)
• Singleton fetus in cephalic presentation confirmed with an ultrasound at the time of presentation for induction of labor
• Cervical exam with Bishop Score <6
• Intact membranes
• Normal vital signs (blood pressure < 140/90, normal body temperature) at the time of presentation for Induction of Labor and within the last 24 hours
• Maternal age ≥18 years of age

Exclusion Criteria:

• Any contraindication for vaginal birth by institutional policy
• Multiple gestation
• History of cesarean delivery
• Oligohydramnios/polyhydramnios/anhydramnios (MVP <2cm)
• Rupture of membranes
• Poorly controlled diabetes (Hgb A1C>8% and/or fingerstick glucose above target >50% of the time in the past week)
• Poorly controlled chronic hypertension, gestational hypertension or preeclampsia (patient requiring IV antihypertensives within 4 hours of arrival)
• Vaginal bleeding
• Any conditions that require continuous electronic fetal monitoring either by institutional policy or provider determination (intrahepatic cholestasis of pregnancy, intrauterine growth restriction, abnormal non-stress test, others)
• Fetal anomaly with anticipated neonatal intensive care unit admission
• Fetal demise
• HIV infection, presence of genital herpetic lesion
• History of substance abuse during this pregnancy
• History of precipitous delivery (delivery <3hrs from onset of labor)
• Poor access to care (social, distance to hospital > 45 min, limited transportation)
• Poor social situation, history of domestic violence, untreated/uncontrolled psychiatric condition
• Inability to give informed consent, history of mental retardation
• Strong preference for inpatient management
• Inability to understand English or Spanish

Pregnant women of diverse ethnic and social background who are at term and have medical indications for delivery and who are recommended to undergo cervical ripening followed by induction of labor. These will be women who are generally healthy and their pregnancy has been uncomplicated.

randomized double blinded