National UK average of Induction of labour (IOL) is 22.1%. It has huge impacts on labour ward and staffing. Most common pharmacological method used is vaginal PGE2 tablet (Prostin), which requires inpatient stay. Alternative ways like PGE2 pessary (propess) might help in avoiding delays in IOL by reducing examinations or even allowing outpatient IOL.Method
A retrospective audit to see delays in IOL in our unit over one-month period. Total inductions were 65 (23.7%), slightly higher than the national average. 49 case notes were retrieved for data analysis.Results
Indications were postdates (16), pre-labour rupture of membranes (6), GDM (2), Obstetric cholestasis (4), PET/PIH (6), SGA (4), IUD (1), APH (3) and others in 7 women. Prostin was primary method of IOL in 25 women (1 prostin in 18, 2 prostins in 4, and 3 prostins in 3). Delay in starting IOL from the time of arrival to delivery suite was assessed for different times during the day. Median delay was 77.5 min (range 0–210 mins, SD 57.61709092506) for times 0820–1200 h, 85.0 min (range 25–1500 mins, SD 427.22569367178) for 1320–1900 h and 255 mins (range 0–1140 mins, SD 494.52628848222) for 1900–2135 h. For emergency IOLs in 4 women the median delay was 207.5 mins (range 17–484 mins, SD 200.0049999375) during the daytime. There were further delays identified in between further prostins or artificial rupture of membranes.Conclusion
Huge delays were noticed in IOLs especially in evening. Introduction of propess might help in reducing delays and also give opportunity for outpatient IOL; however it requires robust setting and regular audit to ensure safety.