Outpatient cervical ripening with Dilapan-S®
may reduce staff time, resource utilization, and overall cost of care.1

US induction of labor rates have risen year over year since 2015 and have more than tripled since 1989.2-4

low-risk women using mechanical methods, outpatient ripening is as safe and effective as inpatient ripening.5,9,10

“[Outpatient labor induction] is at least as effective and safe, if not more, in carefully-selected patient populations, when compared with inpatient inductions.”

—Dong et al., BMC Pregnancy and Childbirth9

Mechanical methods [of cervical ripening] may be particularly appropriate in the outpatient setting.”

—ACOG Guidelines on induction of labor10

“Many centers are moving toward outpatient cervical ripening.”

— Levine and Sciscione, American Journal of Perinatology 5

Outpatient ripening may offer unique benefits to patients and providers


outpatient ripening is associated with increased patient satisfaction

in comparison to inpatient ripening.11-14

  • Hospital admissions have been shown to provoke anxiety and stress among some women11,12
  • Both treatment and placebo study participants in a British outpatient cervical ripening trial would agree to have the same cervical ripening treatment at home during subsequent pregnancies11,12
  • Women in an Australian study were willing to travel an additional 73 minutes to ripen at home14

Shorter hospital stays

Outpatient cervical ripening reduces the time spent in the hospital,

potentially freeing capacity to care for other patients with different needs.1,5,15,16

Outpatient cervical ripening





Limiting patient time in hospital may reduce rates of exposure to SARS-CoV-2 and other airborne infections.17-19

COVID-19 labor and delivery guidance suggests outpatient ripening for low-risk women.17-19

Outpatient ripening research spotlight: Cesarean delivery rates

The most effective way to reduce cesarean-related morbidities is to reduce the primary cesarean section rate.20,21

  • Cesarean delivery carries greater risks of maternal morbidity and mortality than vaginal delivery22
  • The increase in the cesarean rate has not been accompanied by a decrease in rates of neonatal morbidity or mortality22
  • A prior cesarean delivery is the chief indication for a repeat cesarean section20,21

From 2016 to 2017, cesarean deliveries in the US cost on average $4,769 more than vaginal deliveries, with the difference rising to ~$10,000 in some regions.23

Several clinical trials and studies demonstrate that outpatient ripening may reduce cesarean section rates in comparison to inpatient ripening.9,15,24

  • A meta-analysis of 4 randomized controlled trials (RCTs) comparing inpatient and outpatient ripening with balloon catheters found significantly fewer cesarean deliveries in the outpatient group: RR = 0.52 (95% CI [0.30, 0.90])9
  • A recent randomized controlled trial among nulliparous women found that the relative risk of cesarean section was 20% lower with outpatient compared to inpatient cervical ripening; the difference was not statistically significant15

A meta-analysis of 8 RCTs found that outpatient balloon catheter ripening significantly reduced risk of cesarean delivery compared to inpatient ripening: RR = 0.63 (95% CI [0.46, 0.86], P = 0.004.24

CI=confidence interval; RR=relative risk.

Outpatient ripening may increase hospital resource efficiency

When low-risk women can ripen at home, staff time and resources are made available for other patients with different needs.1

  • While pharmacologic ripening methods require extensive fetal monitoring, low-risk women using mechanical methods like Dilapan-S® may be discharged as outpatients25,26
  • Clinical trials show shorter hospital stays with outpatient ripening16,24
  • Shorter hospital stays may reduce the resource and space burden of delivery units5,27,28

Find out how Dilapan-S® can help optimize hospital resource efficiency

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