Primiparous Labour: An Audit Of Management & Outcomes

1. Primiparous Labour: An Audit Of Management & Outcomes S. Walker, J. Rust & L. Olujide Royal Hampshire County Hospital, Winchester, UK Audit Results Background • Caesarean section (CS) rate in Winchester, UK is 26% compared to the national rate of 24% • There is a drive to decrease the CS rate • Primiparous women can be targeted by avoiding their first CS • Labour management aims to optimise the chance of vaginal delivery Outcomes Outcomes • 33% IOL rate of which 61% were post dates • 21% diagnosed with delay in first and 27% in second stage of labour • 32% of all labourers required syntocinon • 24% required syntocinon for delay with a mean time of 55 mins from prescription to commencement (range 0 - 155 mins) • Women with delays of > 60 mins to commence syntocinon had higher rates of operative delivery for failure to progress (73% vs. 38%) Mode of delivery comparing primip & whole pregnant population Mode of delivery for women with delay in 1st stage Aims & Objectives • To evaluate intrapartum management of primiparous women and to gain local outcome data to assist in their counselling • Identification of suboptimal areas and subsequent improvement may influence mode of delivery in this group Standards • 17 standards encompassing induction of labour (IOL), 1st & 2nd stages of labour • Derived from local labour ward guidelines and NICE Intrapartum Care Guideline(London:RCOG Press; 2007) Discussion • Deficiencies in the IOL process and use of syntocinon in the 2nd stage were noted • There was an association between delay from prescription to commencement of syntocinon infusion and waiting for effective epidural analgesia • Reducing the epidural rate in primps might increasenormal vaginal deliveryand reduce operative delivery rates Methods • Retrospective case note audit of 141 primiparous singleton term labourers from January to March 2010 Recommendations Steps to accelerate the induction process. ARM at 0600hrs by the night Registrar followed by syntocinon augmentation at 1 hour Staff education regarding syntocinon; importance of timely commencement and its use in 2ndstage Re-audit in 6 months to assess the impact of this change in practice on CS rate Mode of delivery and analgesia Analgesia use during labour