The goal of the study was to examine the efficacy and risks of cervical ripening in the outpatient situation vs the inpatient setting, or different techniques of ripening in the outpatient setting alone. Using preset criteria and DistillerSR software, 10,853 citations for randomized controlled trials (RCTs) and cohort studies of outpatient cervical ripening with prostaglandins and mechanical techniques in pregnant women at or after 37 weeks of gestation were dual-reviewed. Two reviewers used predefined criteria to extract research data and assess risk of bias. Random-effects meta-analyses were performed, and the level of evidence was appraised. The study included 30 randomized controlled trials and ten cohort studies that were most generalizable to women aged 25–30 years with low-risk pregnancies. All of the findings had a poor or inadequate level of evidence and were not statistically significant. In any comparison of inpatient and outpatient settings, or comparisons of different procedures in the outpatient context, the incidence of cesarean delivery was not different. Harms were reported inconsistently or insufficiently characterized. There were no differences in neonatal infection with outpatient versus inpatient dinoprostone, birth trauma with outpatient versus inpatient single-balloon catheter, shoulder dystocia with outpatient dinoprostone versus placebo, maternal infection with outpatient versus inpatient single-balloon catheters or outpatient prostaglandins versus placebo, or postpartum hemorrhage with outpatient catheter versus inpatient dinoprostone. There was inadequate evidence on misoprostol, hygroscopic dilators, and other consequences.
Outpatient cervical ripening with dinoprostone or single-balloon catheters did not increase cesarean births in women with low-risk pregnancies. Although there were no significant differences in risks between outpatient and inpatient cervical ripening, the confidence of evidence is poor or insufficient to establish decisive judgments.