Introduction

1. Induction of Labour practices – AN Audit of Obstetricians’ compliance to guidelines Kelly Goodwin, Roxanna Mohammed, Jenna Rainey, Yanfang Guo, George Tawagi, Lawrence Oppenheimer, Mark Walker, Jessica Dy Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, University of Ottawa Results Results • Introduction • Induction of labour (IOL) occurs when the risks of continuing the pregnancy outweigh the risks of induction. At The Ottawa Hospital (TOH), the rate of IOL has increased by 57.7% from 2002 to 2009. The objective of this quality improvement project is to review the indications for IOL at TOH and assess Obstetricians’ compliance rate at meeting criteria for specific maternal/fetal indications for induction. • Method • A retrospective cohort study of IOL was completed at TOH between July 2010 and June 2011. • The Niday Perinatal Database was used to identify patients who underwent induction of labour. • In depth chart review was conducted for specific indications of IOL: • Diabetes • Preecclampsia or Gestational Hypertension • Oligohydramnios • Intrauterine Growth Restriction (IUGR) and Small for Gestational Age (SGA) • Criteria for each indication were generated from national guidelines. • The chart review was completed by an Obstetric resident and each patient was coded as either having “met criteria” or “not met criteria” for IOL • Criteria for IOL • Diabetes • Pre-existing Type 1 or 2 Diabetes, no complications • If on insulin, > 38 weeks GA • Gestational Diabetes, no complications • If on insulin, > 38 weeks GA • No indication if diet controlled • Diabetes with complications • Includes decreased insulin needs, polyhydramnios, SGA or IUGR etc. • Preecclampsia or Gestational Hypertension • Severe Preecclampsia • DBP > 110, proteinuria + adverse conditions • Mild/Moderate Preecclampsia • DBP > 90 + proteinuria or adverse conditions, > 37 weeks GA • Gestational Hypertension • DBP > 90, NO proteinuria/adverse condition, > 39 weeks GA • Oligohydradmnios • No 2x2 amniotic fluid pocket • IUGR or SGA • EFW < 10th %ile + other abnormal parameters (dopplers, BPP, NST) • EFW < 10th %ile, otherwise uncomplicated > 38 • Flattening of growth curve (as judged by a clinician) Compliance to Induction Criteria Retrospective Chart Review Association Between Meets Criteria and Risk of C/S Overall IOL Rate is 24.05% *Adjusted for maternal age, maternal parity, maternal BMI, fetal birth weight, gestational age at delivery. Indications for Induction • Conclusions • TOH Overall Induction Rate from July 2010 – June 2011 is 24.05%. • 25% of Inductions did not meet induction criteria for specific indications. • Post dates inductions account for 27.8% of inductions, however 93% occur after 41 weeks GA. • Inductions that met criteria had a higher c/s rate. • Inductions that did not meet criteria had an unnecessary intervention that may have increased their risk of c/s relative to expectant management. • Educational workshops, knowledge translation activities, and an ongoing internal audit of IOL practices may help improve compliance to IOL guidelines. Analysis Post Dates IOL Compliance Funding