Prostaglandin insert dinoprostone versus trans-cervical balloon catheter for outpatient labour induction: A randomised controlled trial of feasibility (PROBIT-F)

Abstract

<i>Background</i> - The aim was to assess the feasibility of conducting a randomised controlled trial (RCT) of induction of labour comparing use of two methods in the outpatient setting.<p>

<p><i>Methods</i> - An open-label feasibility RCT was conducted in two UK maternity units from October 2017 to March 2019. Women aged ≥ 16 years, undergoing induction of labour (IOL) at term, with intact membranes and deemed suitable for outpatient IOL according to local guidelines were considered eligible. They were randomised to cervical ripening balloon catheter (CRB) or vaginal dinoprostone (Propess). The participants completed a questionnaire and a sub-group underwent detailed interview. Service use and cost data were collected via the Adult Service Use Schedule (AD-SUS). Women who declined to participate were requested to complete a decliners’ questionnaire.<p>

<p><i>Results</i> - During the study period, 274 eligible women were identified. Two hundred thirty (83.9%) were approached for participation of whom 84/230 (36.5%) agreed and 146 did not. Of these, 38 were randomised to Propess (<i>n</i> = 20) and CRB (<i>n</i> = 18). Decliner data were collected for 93 women. The reasons for declining were declining IOL (<i>n</i> = 22), preference for inpatient IOL (<i>n</i> = 22) and preference for a specific method, Propess (<i>n</i> = 19). The intended sample size of 120 was not reached due to restrictive criteria for suitability for outpatient IOL, participant preference for Propess and shortage of research staff.<p>

<p>The intervention as randomised was received by 29/38 (76%) women. Spontaneous vaginal delivery was observed in 9/20 (45%) women in the dinoprostone group and 11/18 (61%) women in the CRB group. Severe maternal adverse events were recorded in one woman in each group. All babies were born with good condition and all except one (37/38, 97.4%) remained with the mother after delivery. No deaths were recorded. − 21% of women in <the dinoprostone group were re-admitted prior to diagnosis of active labour compared to 12% in the CRB group.<p>

<p><i>Conclusions</i> - A third of the approached eligible women agreed for randomisation. An RCT is not feasible in the current service context. Modifications to the eligibility criteria for outpatient IOL, better information provision and round the clock availability of research staff would be needed to reach sufficient numbers.