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?