(1096) The HOME INDUCTION Randomized Controlled Trial – Logistics for achieving delivery

The ARRIVE Trial has resulted in an increased demand for 39 week induction of labour (IOL) in normal-risk nulliparous patients, but this creates significant logistical challenges for already busy Labor Wards. A potential solution is commencing induction by means of outpatient cervical ripening at home (H-IOL), using vaginal prostaglandin (Propess/Cervidil) or osmotic cervical dilator (Dilapan-S). This secondary analysis evaluates the logistics of achieving vaginal delivery, including time taken and need for additional ripening modality.


Study Design:

We randomized healthy nulliparous women, who agreed to elective IOL at 39 weeks, to one of three forms of initial cervical ripening at home: 12 hours of Dilapan (D12), 24 hours of Dilapan (D24), or 24 hours of Propess/Cervidil (P24). Patients returned to the hospital after 12 or 24 hours for either amniotomy or, if the cervix remained unripe, additional doses of prostaglandin E2 gel (Prostin, 1mg). Time to delivery and need for additional Prostin were assessed as part of this secondary analysis.


Results:

Patients randomized to Dilapan (D12/D24) were significantly more likely to require an additional agent (Prostin, 1mg) prior to amniotomy being possible (64.5% vs 34%, p< 0.001). There was no difference in oxytocin use between groups. Table 1 also shows the timeframe of delivery for each group. 66% of all nulliparous women delivered within 48 hours after IOL commenced, and 94% delivered within 72 hours, inclusive of the time period spent at home.


Conclusion:

Home IOL is an efficient and useful option for dealing with logistical challenges in busy Labor Wards, with the majority of nulliparous patients delivering within 48 hours. However, there are significant differences in performance characteristics of different modalities for H-IOL, with the majority of Dilapan patients requiring additional Prostin. Outpatient Propess appears to have the most favorable, successful vaginal delivery profile. These RCT data will be useful for Labor Ward planning, including optimizing staffing levels and bed availability.