1. Northern England Strategic Clinical Network Conference 15 th May 2015 Induction of Labour at Term Plus 7 at JCUH Helen Simpson, Alison Russell, Yvonne Regan

2. Change Previous practice IOL for post dates at 40+13 New practice IOL for post dates at 40+7

3. Management of Increased Work Load Timing for IOL – Multips, VBACs and Twins commenced am – Primips commenced pm T+7 low dependency IOL managed initially on AN ward Peak activity extend to T+8

4. Induction Process Review Retrospective audit of 70 sets of notes of induction at T+7 Compared 2013 with 2014 inductions

5. Influence of Sweeps % of Women Requiring Prostin & Syntocinon 20132014 Primip + Sweep31%45% Primip + No sweep62%68% Multip + Sweep3%4% Multip + No Sweep26%34% 86% of those women requiring > 1 prostin did not have a sweep

6. Length of Antenatal & labour Stay 48hrs < 12hrs12-24hrs>24hrs 2013 Primip 16%50%34% 2014 Primip 20%54%26% 2013 Multip 36% 28% 2014 MUltip 53%41%6%

7. Epidural 20132014 Primip71%46% Multip12%9%

8. Outcome Measures – pre and post change

9. Method Compare like for like Compared ALL Term plus 7 deliveries Data for the whole of 2013 compared to data from 2014 intervention period July - Dec 31st Computer data for SVD data and LSCS & operative vaginal databases

10. Summary Labour Onset 20132014 Spontaneous labour64.5%18.9% IOL33.5% 0.85 per day 80.4% 2.2 per day Em LSCS no labour0.5%0 El LSCS1.4%0.6% Total921491 4.7% opted to wait beyond Term +7

11. Mode of Delivery No effect on overall LSCS rate

12. Summary Reason LSCS 20132014 Lack progress, including failed instrumental 47 (33.3%)26 (40%) Failed IOL * 8 (5.7%)3 (4.6%) Path CTG including cord prolapse 77 (54.6%)34 (52.3%) Breech5 (3.5%)1 (1.5%) Other4 (2.8%)1 (1.5%) *Failed IOL = unable to ARM

13. Parity and Mode of Delivery: PrimipSVDOp VagLSCS 201347.9%29.9%22.2% 201444.5%33%22.5% MultipSVDOp VagLSCS 201389.8%3.9%6.3% 201492.6%4.3%3.1%

14. Summary Fetal Outcome 20132014 Apgar <7 at 5min2.4%1.2% Aph < 7.00.3%0.6% Aph <7.13.9%4.7% NNU admission1.2%0.8% IUD0.57 / 1000 (previous 30 months = 10528 deliveries) 0 / 1000

15. Summary Maternal Outcomes 20132014 ITU admission0.2%0 Blood transfusion1.3% *1.8% PPH > 1l6.2%3.5% PPH >2l0.6%0.4% Shoulder dystocia1.4%2.4% ** * Data on blood transfusions not available for SVD in 2013 ** Unable to differentiate difficulty with and shoulder dystocia for SVD

16. Timing of Delivery Percentage operative delivery between 10pm and 8am (No consultant present) 20132014 43.2%49.3% Primip IOL 35.8% “out of hours”

17. Summary (1) <5% declined Induction at 41 weeks The LSCS rate is UNCHANGED Slight increase in the rate of LSCS for lack of progress Slight decrease in LSCS for path CTG No increase in the failed IOL rate

18. Summary (2) Possible reduction on still birth – further years data required No detrimental fetal effect No detrimental maternal effect

19. Thank you, Any Questions?