Introduction: The aim was to evaluate the outcomes of women undergoing induction of labour (IOL) at a Tertiary Metropolitan Hospital in Western Australia (WA) in accordance with the ACHS Indicator 1.21. The study was driven by the most recent ACHS data that IOLs have reached their highest rate in history of 31.6% with rates being highest in WA. These women are high risk in the antenatal and intrapartum period and contribute to a large burden of workload within the Maternity department.
Methods: We audited 50 cases of women undergoing inpatient IOL within a 3 month period (July to September 2018) at a Tertiary Metropolitan Hospital of WA. This represented 16% of all IOL cases (n=310) for that period and 4.5% of total births (n=1096). Data was collected from electronic records and analysed via SPSS using simple statistics.
Results: In the period analysed our IOL rate was 28%. The majority of women were nulliparous (58%) and had Gestational Diabetes Mellitus (GDM) requiring Insulin (32%). 68% of women required cervical ripening and 24% required a second ripening method. Delivery was primarily spontaneous vaginal delivery (44%), followed by instrumental (40%) and emergency caesarean section (16%). Of those that required caesarean section, majority were nulliparous (87.5%) and unfavourable on admission (100%) and half had GDM requiring insulin.
Discussion: Women undergoing IOL represent a significant proportion of women delivering at our hospital. Women with GDM on Insulin account for a major allocation of resources for IOL. Nulliparous women undergoing IOL required increased intervention for cervical ripening and birth. This information can help us to allocate resources effectively, improve workflow and aid the expectation of other hospitals becoming specialist centres for GDM. Looking to the future, a service improvement project is currently underway in order to streamline the IOL process with particular focus on the policy surrounding women with GDM-I.