Objective To determine whether home cervical ripening is associated with acceptable safety margins compared to in-hospital cervical ripening during induction of labour. Design A prospective multicentre observational cohort study using routinely collected data. Setting Twenty-six UK maternity units; 18 offering only in-hospital cervical ripening and 8 offering both in-hospital and home cervical ripening. Population Women with singleton pregnancies, no previous caesarean section, at or beyond 37 weeks gestation having induction with details of cervical ripening method and location recorded. Methods Home cervical ripening using a balloon catheter was compared to in-hospital cervical ripening using prostaglandin. Multivariable logistic regression was performed for the primary outcome. Exposure: Cervical ripening at home using balloon catheter. Main outcome measures Primary outcome: neonatal unit admission within 48 hours of birth for 48 hours or more. Additional neonatal, maternal, labour progress and process outcomes were reported. Results Of 17,530 eligible women, 515 had balloon cervical ripening at home and 4332 had prostaglandin cervical ripening in a hospital that did not offer home cervical ripening. The primary outcome following home cervical ripening with balloon was not higher {16/515 (3.1%) vs 208/4332 (4.8%)}, but with substantial uncertainty on adjusted analysis consistent with a 64% lower risk through to an 81% higher risk. Conclusions Home cervical ripening using balloon catheter may be as safe for babies as using prostaglandin in hospital in low and moderate-risk groups, but further safety data are required.

Background: Postpartum haemorrhage (PPH) rates are increasing in developed countries. A reliable prognostic tool for PPH has potential to aid prevention efforts. Objective: To systematically identify and appraise prognostic modelling studies for prediction of PPH. Search strategy: MEDLINE, Embase, CINAHL and the Cochrane Library were searched using a combination of terms and synonyms including ‘prediction tool’, ‘risk score’ and ‘postpartum haemorrhage’. Selection criteria: Any observational or experimental study developing a prognostic model for women’s risk of PPH. English language publications. Data collection and analysis: Predesigned data extraction form to record: data source; participant criteria; outcome; candidate predictors; actual predictors; sample size; missing data; model development; model performance; model evaluation; interpretation. Main Results: Of 1723 citations screened, 10 studies were eligible for inclusion. An additional paper was published and identified following completion of the search. Studies addressed populations of women who experienced; placenta praevia; vaginal births; caesarean birth; and the general obstetric population. Primary study authors deemed four models to be confirmatory. There was a high risk of bias across all studies due to a combination of retrospective selection of women, low sample size, no internal validation, suboptimal external validation and no reporting of missing data. Conclusion: Of eleven prognostic models for PPH risk, one developed for women undergoing caesarean section is deemed suitable for external validation. Future research requires robust internal and external validation of existing tools and development of a model that can be used to predict PPH in the general obstetric population. Protocol registration number: PROSPERO 95587

Background There is currently no consensus regarding the outcomes and outcome measures that should be reported in studies assessing planned mode of birth. Objectives To develop an inventory for reported outcomes for studies comparing planned caesarean section (CS) and planned vaginal delivery (VD) for women age 18-45. Search strategy Three online databases, Ovid SP version of MEDLINE and EMBASE and the Cochrane Pregnancy and Childbirth Group’s Trials Register, were searched from 2011 to June 2019. Selection criteria The inclusion criteria were: prospective studies evaluating planned mode of birth, age 18-45, singleton pregnancy, gestational age 37-40 weeks, >100 participants, middle or high income countries. No language restrictions were applied. Data collection and analysis Two researchers independently screened titles and abstracts, and subsequently reviewed the full text of each selected study to assess for eligibility. Discrepancies were resolved by discussion with a third author. The selected studies were evaluated using the MOMENT criteria. Outcomes and outcome measures were systematically extracted and organised into an inventory. Main results 63 prospective studies including data from 6,397,310 women were included. Based on the MOMENT score of 4 or more, 37 studies (59%) were of high quality. In total, 43 different primary outcomes and 79 different primary outcome measures were identified; 12 different secondary outcomes and 31 secondary outcome measures were identified. The primary outcome measurements and definitions of outcomes were inconsistent. Conclusions Prospective studies evaluating outcomes of planned mode of birth frequently report different primary outcomes and outcome measures. Funding: None required