Induction of labour: how close to the evidence-based guidelines are we?

The aim of this study was to assess the indications and methods used for induction of labour (IOL), to determine whether induction was performed as per local guidelines, to ensure the Royal College of Obstetricians and Gynaecologists/National Institute for Clinical Excellence (RCOG/NICE) guidelines were adhered to within the department and finally, identify areas for improvement in women's care. We retrospectively analysed 95 cases of IOL managed between 1 May and 30 June 2003 at City Hospital, Birmingham, UK. A total of 95 out of 569 (16.7%) deliveries were induced over the period of study. Indications for IOL and their documentation in the case-notes showed 60 - 70% compliance with guidelines. Pre-IOL cervical ripening with prostaglandin E2 (PGE2) was performed in 42 cases out of 65, showing 64.6% compliance with guidelines. All cases who had pre-IOL cervical ripening with PGE2 were closely monitored during ripening, showing 100% compliance. A total of 79 cases out of 95 (83.2%) achieved vaginal delivery. However, eight of those (8.4%) required instrumental delivery. More than 50% of women delivered within 12 h of starting IOL. Five cases (5.3%) had failed IOL. The overall caesarean section (CS) rate was 16.8%. Maternal and fetal complications were relatively uncommon during the study period. Uterine hyperstimulation was reported in only one case (1.1%) in this study. Full compliance with evidence-based guidelines was achieved in some aspects of this audit, while other aspects showed no or little compliance. IOL is an effective and safe intervention in modern obstetric practice. Regardless of cervical status and parity, vaginal delivery can be anticipated in the majority of women undergoing labour induction.