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Outpatient Induction of Labour
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Outpatient Induction of Labour

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  • 1. Outpatient IOL Philippa Cox
  • 2.
    • Trialed in 2007 for one year
    • Women who are post dates
    • Women who have had a low risk pregnancy
  • 3. Benefits
    • Keeps low risk women out of hospital
    • Enables women to stay with their family
    • Keeps A/N beds free for women who really need them
    • Maintains the message that pregnancy and birth is normal
  • 4. Audit 2010 (Feb / March)
    • Total IOL = 65
      • Inpatient IOL = 49
      • Outpatient IOL = 16 (of which 2 were admitted before IOL)
  • 5. Parity
  • 6. Indication for IOL
  • 7. Gestation at delivery
  • 8. Mode of Delivery 8/16 OP 17/49 IP 6/16 OP 24/49 IP 2/16 OP 4/49 IP 4/49 IP
  • 9. IOL – Delivery Interval <12h 12-24h 24-36h 36-48h >48h OP 25% 25% 25% 25% 0% IP 43% 29% 12% 8% 8%
  • 10. Fetal Outcome 94% 98% 1 low apgars 2,9,10, observed in SCBU 1 RDS & neonatal sepsis, admitted to SCBU for Abx and breathing support Note ; 2 other admissions to SCBU for observation from IP group, no complications
  • 11. Maternal Outcome 96% 87.5% 2 PPH >1000ml 1 PPH 1000ml, 1 HTN (d/c PN D7)
  • 12. Process
    • Community midwives (CMW) offer membrane sweep from 40/41 weeks
    • Cmw arranges outpatient IOL, gives IOL leaflet with appointment details
    • Woman attends OAU for Ctg and prostin.
    • Post prostin and Ctg is NAD goes home with time to return to antenatal ward to continue the process next day.
  • 13.
    • If spont labour overnight goes to Delivery suite & is assessed. If remains low risk to Birth centre
    • Following morning - If requires 2 nd prostin goes to antenatal ward at this point would not go to the birth centre.
  • 14. Consider
    • Where the OP IOL’s will be undertaken
    • Capacity on ward to continue IOL process
    • Information leaflets
    • Start small then Audit
  • 15.
    • Any Questions?

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