SDMS ID: P2010/0321-001 WACSClinProc1.

10 Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Purpose: A policy of offering routine induction after 41 weeks reduces perinatal mortality without increasing the caesarean section rate. 500 inductions of labour may be necessary to prevent one perinatal death. Routine early pregnancy ultrasound examination and subsequent adjustment of delivery date appear to reduce the incidence of post term pregnancy. Procedure: Women should have a doctors appointment in antenatal clinic at 41 completed weeks of pregnancy. Women should be offered induction after 41 + 3 days. Vaginal examination should be performed to ascertain Bishops score and to plan method of induction. Complete Bishop score and place sticker in notes. If ripening agents required complete medical chart. Book induction through 4B ext 8960 Inform all women that induction of labour may be postponed as urgent cases take priority. Women who decline induction of labour should be offered a management plan including increased fetal surveillance in the Pregnancy Assessment Unit: Weekly USS to measure AFI Twice weekly CTG monitoring Risks of Induction of Labour Cord prolapse Uterine rupture Postpartum haemorrhage Requiring an epidural Requiring an operative vaginal birth Requiring a caesarean section Induction of Labour for Post Maturity New guideline Induction of labour for post maturity Midwifery and Medical Staff, Queen Victoria Maternity Unit Induction, post dates

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Attachments Attachment 1 Attachment 2 Attachment 3 Attachment 4

(PAC) Monitoring of Prolonged Pregnancy Clinical Notes Bishops Score References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years via Policy and Procedure working group coordinated by the Clinical and Quality improvement midwife. November 2009 Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: _________________________

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APPENDIX 1 Pregnancy Assessment Unit Monitoring of Prolonged Pregnancy

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APPENDIX 2 Clinical Notes Data from a cohort study revealed that at 40 weeks only 58% of women had delivered. This increased to 74% by 41 weeks and 82% by 42 weeks. An ultrasound to confirm gestation should be offered before 20 weeks gestation as this reduces the need for induction for perceived post term pregnancy Women with uncomplicated pregnancy should be offered induction of labour beyond 41 weeks. From 42 weeks women who decline induction of labour should be offered increased antenatal monitoring consisting of twice weekly CTG and ultrasound examination of amniotic fluid index. Induction of labour for maternal request prior to 41 weeks may be considered when resources permit and there are compelling psychological or social reasons and the women has a favourable cervix.

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APPENDIX 2 Bishops Score SCORE Dilation Length of Cervix Station Consistency Position

0 0 3 -3 Firm Posterior

1 1-2 2 -2 Medium Mid

2 3-4 1 -1 Soft Anterior TOTAL

3 5+ 0 0

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APPENDIX 3 REFERNCES Crowley P. Interventions for preventing or improving the outcome of delivery at or beyond term Cochrane Database of Systematic Reviews 1997, Issue 1. Art. No.: CD000170. DOI: 10.1002/14651858.CD000170. National Institute for Clinical Excellence Clinical Guideline D 2001 Induction of labour. Online: http://www.nice.org.uk

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