MATERIAL AND METHODS: A randomized trial was conducted in the University of Malaya Medical Center. A total of 163 term multiparas (no dropouts) with unripe cervixes (Bishop score ≤5) scheduled for labor induction were randomized to outpatient or inpatient Foley catheter. Primary outcomes were delivery during "working hours" 08:00-18:00 h and maternal satisfaction on allocated care (assessed by 11-point visual numerical rating score 0-10, with higher score indicating more satisfied).
CLINICAL TRIAL REGISTRATION: ISRCTN13534944.
RESULTS: Comparing outpatient and inpatient arms, delivery during working hours were 54/82 (65.9%) vs. 48/81 (59.3%) (relative risk 1.1, 95% CI 0.9-1.4, p = 0.421) and median maternal satisfaction visual numerical rating score was 9 (interquartile range 9-9) vs. 9 (interquartile range 8-9, p = 0.134), repectively. Duration of hospital stay and membrane rupture to delivery interval were significantly shorter in the outpatient arm: 35.8 ± 20.2 vs. 45.2 ± 16.2 h (p = 0.001) and 4.1 ± 2.9 vs. 5.3 ± 3.6 h (p = 0.020), respectively. Other maternal and neonatal secondary outcomes were not significantly different.
CONCLUSIONS: The trial failed to demonstrate the anticipated increase in births during working hours with outpatient compared with inpatient induction of labor with Foley catheter in parous women with an unripe cervix. Hospital stay and membrane rupture to delivery interval were significantly shortened in the outpatient group. The rate of maternal satisfaction was high in both groups and no significant differences were found.
STUDY DESIGN: A survey was conducted by electronic questionnaire to obstetricians across Wales and midwives across North Wales. The questionnaire was distributed to obstetricians using the Wales Information System. Midwives were surveyed using a health board wide distribution list. This was followed by a literature review using dictionaries, standard texts, professional bodies and websites. References were obtained for the UK, USA, India, Malaysia and West Indies.
RESULTS: There were 143 responses from 63 doctors and 80 midwives. 5% of doctors and 49 % of midwives did not include stillbirths after 24 completed weeks in their definition of parity. 84 % of all surveyed described having a previous twin delivery as Para 2. 23 references were obtained for a definition of parity. Parity was variability defined as the number of conceptions, pregnancies, births and babies. Only 12 sources offered a definition in reference to multiple pregnancy. Of these, 8 sources defined multiple births as a single parous event.
CONCLUSIONS: There are variations in definitions for the term parity from referenced sources and variation in understanding amongst staff surveyed. We recommend UK professional bodies take into consideration the findings of this study and provide a standard consensus definition of parity.