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Objective In the OFFSITE II randomized controlled trial, outpatient cervical ripening with a Foley catheter (CF) in nulliparous patients undergoing elective induction of labor (eIOL) shortened the time from admission to delivery. Given that patients with obesity have protracted labor and higher rates of failed IOL, we sought to determine if outpatient ripening with a CF may be even more beneficial for this high-risk group. Study Design We performed a secondary analysis of the OFFSITE II randomized controlled trial. For this analysis, all patients from the primary trial were classified by their intervention assignment (inpatient vs. outpatient) and also by their admission body mass index (BMI) class (BMI ≥ 30 and BMI < 30 kg/m 2). The primary outcome was time from labor and delivery (L&D) admission to delivery. Secondary outcomes included cesarean delivery, time from admission to hospital discharge, and rates of clinically diagnosed chorioamnionitis and endometritis. Results In patients with BMI ≥ 30, the primary outcome, time from admission to delivery, (18.0 [13.5–20.9] vs. 20.4 [16.6–31.3] hours, p = 0.01), as well as total hospitalization length (3.2 [2.5–3.3] vs. 3.4 [3.1–4.3] days, p = 0.02) were shorter in the outpatient group. There were no differences in rates of chorioamnionitis or endometritis in outpatient compared with inpatient CF. Furthermore, in those with a BMI ≥ 30, the cesarean rate was significantly lower with outpatient CF (19.4% vs. 44.7%, p = 0.03); it was not statistically different in patients with BMI < 30. Conclusion In this exploratory retrospective secondary analysis of the OFFSITE II randomized control trial, we found that in patients with BMI ≥ 30 undergoing eIOL, outpatient CF was associated with a lower time from L&D admission until delivery. This was also associated with a shorter time of total hospital duration and decreased the rate of cesarean, a benefit not detected in the overall analysis presented in the primary study. In nulliparas undergoing induction of labor, ripening with outpatient cervical Foley may even more significantly reduce labor duration, total hospital duration, and the rate of cesarean in patients with obesity. Key Points Outpatient CF was associated with a lower time from L&D admission until delivery in obese nulliparas. Outpatient CF was associated with a shorter time of total hospital duration in obese nulliparas. Outpatient CF was associated with a decreased rate of cesarean birth in obese nulliparas. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to assess whether patient satisfaction differs between women beginning cervical ripening in the outpatient versus inpatient setting. Study Design  We performed a planned secondary analysis evaluating patient satisfaction randomized to outpatient versus inpatient cervical ripening. In the original randomized controlled trial, low-risk parous women ≥39 weeks who required cervical ripening for induction and had reassuring fetal heart rate monitoring were included and randomized to inpatient versus outpatient ripening with a transcervical Foley's catheter. All women were then admitted to the labor ward on the following day. Patient satisfaction was evaluated using three separate surveys. The first two surveys, Six Simple Questions and Lady-X, were previously validated. The third survey used visual analog scales to assess overall pain experienced during Foley's placement, overall pain experienced during labor, how likely they would be to choose the same type of care for their next pregnancy, and how likely they would be to recommend their method of cervical ripening to friends/family. Results  From May 2016 to October 2017, 129 women were randomized (outpatient, 65; inpatient, 64). Based on survey results, there was no difference in satisfaction between outpatient and inpatient cervical ripening with transcervical Foley's catheterization, with high satisfaction in both groups. Patients in both the outpatient and inpatient groups would choose the same type of care for their next pregnancy (on a scale of 1–7, median (25th–75th percentile): 7 [7–7] vs. 7 [6–7], respectively, p  = 0.75) and would be very likely to recommend their method of induction to a friend or family member (on a scale of 0–100, 99 [80–100] vs. 99 [65–100], respectively, p  = 0.60). Conclusion  Parous women's satisfaction does not differ between inpatient and outpatient cervical ripening with transcervical Foley's catheterization. Key Points Outpatient cervical ripening may allow providers to incorporate the benefits of electively inducing women as well as decrease the time spent in the labor and delivery unit. Parous women's satisfaction does not differ between inpatient and outpatient cervical ripening with transcervical Foley. Additional prospective evaluation is warranted to further characterize patient preferences in relation to the location of cervical ripening. [ABSTRACT FROM AUTHOR]