Post on 28-Nov-2014
description
Outpatient IOL
Philippa Cox
• Trialed in 2007 for one year
• Women who are post dates
• Women who have had a low risk pregnancy
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
Audit 2010 (Feb / March)
• Total IOL = 65
– Inpatient IOL = 49
– Outpatient IOL = 16 (of which 2 were admitted before IOL)
Parity
12%
11%
3%
0%
5%
69%
P0
P1
P2
P3
P4
P5
Indication for IOL
7557
6.25
16
6
6.252 46.256.2515
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Inpatient Outpatient
Other
Maternal Request
Maternal Age
PET
SROM
Postdates
Gestation at delivery
0%23%
22%55%
<3737-4040-41>41
Mode of Delivery
47%
6%9%
38%
SVD
Ventouse
Forceps
Em c/s
8/16 OP17/49 IP 6/16 OP
24/49 IP
2/16 OP4/49 IP 4/49
IP
IOL – Delivery Interval
<12h 12-24h 24-36h 36-48h >48h
OP 25% 25% 25% 25% 0%
IP 43% 29% 12% 8% 8%
Fetal Outcome
0 10 20 30 40 50 60
Inpatient
Outpatient
Good
Complications
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
Maternal Outcome
0 10 20 30 40 50 60
Inpatient
Outpatient
Good
Complications
96%
87.5%2 PPH >1000ml
1 PPH 1000ml, 1 HTN (d/c PN D7)
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.
• If spont labour overnight goes to Delivery suite & is assessed. If remains low risk to Birth centre
• Following morning - If requires 2nd prostin goes to antenatal ward at this point would not go to the birth centre.
Consider
• Where the OP IOL’s will be undertaken
• Capacity on ward to continue IOL process
• Information leaflets• Start small then Audit
Any Questions?