Objective: To compare childbirth satisfaction and obstetrical outcomes with outpatient versus inpatient induction of labour (IOL). Design: Multicentre, randomised-controlled trial Setting: Eight hospitals in Norway. Population: A total of 283 women scheduled for IOL with single cephalic presentation, ≥ 37 weeks, no previous uterine scar and low risk of complications by predefined criteria, were randomised to outpatient or inpatient setting, after stratification by parity. Methods: All women received 25ug oral misoprostol as primary induction agent, for up to 48 hours/12 tablets. If labour was not established, further IOL with secondary induction agents was continued in hospital for all women. The Childbirth Experience Questionnaire (CEQ) and the Experience with Induction Tool (EXIT) was used to assess childbirth satisfaction. Main outcome measures: Childbirth satisfaction. Secondary outcome measures: Obstetrical outcomes. Results: Of 283 women randomised, 152 women were assigned to outpatient and 131 to inpatient setting. Outpatient IOL resulted in a more positive childbirth experience (mean CEQ-score 3.1 (0.44) vs. 3.0 (0.45), p=0.01 with multiparous women reporting highest satisfaction (mean EXIT-score 3.6 (0.63) vs. 3.3 (0.61), p=0.03 and mean CEQ-score 3.3 (0.39) vs. 3.1 (0.43), p<0.01. In the outpatient group, 101 women (67%) were admitted to hospital due to contractions, 25 (28%) required further IOL. Obstetrical outcomes were alike and there were no cases of hyperstimulation in the latent phase or serious adverse events observed. Conclusion: Outpatient IOL with oral misoprostol resulted in higher childbirth satisfaction with similar obstetrical outcomes compared to inpatient IOL. This method should be an option to selected women.

Objective: To validate an intrapartum Cesarean Section Classification System (ICSCS). Design: Nationwide prospective observational study. Setting: Twenty-five Norwegian maternity units Population or Sample: Singleton cephalic pregnancies with spontaneous or induced labour at ≥ 37 weeks gestation delivering February-August 2017. Methods:. After training of all collaborators, Cesarean section (CS) after spontaneous or induced labour were classified based on fetal status, dynamic progress in labour, use of oxytocin, frequency of contractions and linked to denominator data collected and centralized by the Norwegian Medical Birth Registry. Main Outcome Measures: Cohens kappa as measure of agreement for correct application of the classification. Prevalence of the different groups using the ICSCS within the Ten Group Classification System (Robson groups). Results: Of 49 trained experts, 40 (82%) had a κ >0.6 indicating good or very good level of agreement when the classification was applied. A total of 1425 CS were classified: CS classified as fetal indication (no oxytocin) was more common in induced (Group 2a, 4a, 5b) compared to spontaneous labours (Group 1, 3, 5a). CS classified as dystocia related to inefficient uterine action and poor response to oxytocin occurred more often in induced as compared to spontaneous labours. The prevalence of CS classified as dystocia with efficient uterine action (malposition or cephalopelvic disproportion) was low in all Robson groups. Conclusions: The ICSCS was successfully validated in a national study. It may become a valuable objective tool for analyzing the management of labour and explaining differences in the prevalence of CS between different groups of women.