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Maternity and Neonatal Clinical Guideline

Queensland Health Translating evidence into best Clinical practice EXTENSION OF REVIEW DATE RELEVANT TO Induction of labour Clinical Guideline ( ) DATE OF EXTENSION 13 May 2022 NEW REVIEW DATE March 2023 CONTENT AFFECTED Date of review only. No other amendments RATIONALE Original review date (March 2022) exceeded Content remains current Review in progressAUTHORISED BY Queensland Clinical guidelines Steering Committee Maternity and NeonatalClinical GuidelineQueensland Health Induction of labour Queensland Clinical Guideline : Induction of labour Refer to online version, destroy printed copies after use Page 2 of 30 Document title: Induction of labour Publication date: March 2017 Document number: MN17.

Health professionals in Queensland public and private maternity and neonatal services Review date: March 2022 . Endorsed by: Queensland Clinical Guidelines Steering Committee . Statewide Maternity and Neonatal Clinical Network (Queensland) Contact: Email: Guidelines@health.qld.gov.au

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Transcription of Maternity and Neonatal Clinical Guideline

1 Queensland Health Translating evidence into best Clinical practice EXTENSION OF REVIEW DATE RELEVANT TO Induction of labour Clinical Guideline ( ) DATE OF EXTENSION 13 May 2022 NEW REVIEW DATE March 2023 CONTENT AFFECTED Date of review only. No other amendments RATIONALE Original review date (March 2022) exceeded Content remains current Review in progressAUTHORISED BY Queensland Clinical guidelines Steering Committee Maternity and NeonatalClinical GuidelineQueensland Health Induction of labour Queensland Clinical Guideline : Induction of labour Refer to online version, destroy printed copies after use Page 2 of 30 Document title: Induction of labour Publication date: March 2017 Document number: MN17.

2 22-V7-R22 Document supplement: The document supplement is integral to and should be read in conjunction with this Guideline Amendments: Full version history is supplied in the document supplement Amendment date: July 2018 Replaces document: Author: Queensland Clinical guidelines Audience: Health professionals in Queensland public and private Maternity and Neonatal services Review date: March 2022 Endorsed by: Queensland Clinical guidelines Steering Committee Statewide Maternity and Neonatal Clinical Network (Queensland) Contact: Email: URL: Disclaimer This Guideline is intended as a guide and provided for information purposes only. The information has been prepared using a multidisciplinary approach with reference to the best information and evidence available at the time of preparation.

3 No assurance is given that the information is entirely complete, current, or accurate in every respect. The Guideline is not a substitute for Clinical judgement, knowledge and expertise, or medical advice. Variation from the Guideline , taking into account individual circumstances, may be appropriate. This Guideline does not address all elements of standard practice and accepts that individual clinicians are responsible for: Providing care within the context of locally available resources, expertise, and scope ofpractice Supporting consumer rights and informed decision making in partnership with healthcarepractitioners, including the right to decline intervention or ongoing management Advising consumers of their choices in an environment that is culturally appropriate andwhich enables comfortable and confidential discussion.

4 This includes the use of interpreterservices where necessary Ensuring informed consent is obtained prior to delivering care Meeting all legislative requirements and professional standards Applying standard precautions, and additional precautions as necessary, when deliveringcare Documenting all care in accordance with mandatory and local requirementsQueensland Health disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in negligence) for all expenses, losses, damages and costs incurred for any reason associated with the use of this Guideline , including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable.

5 State of Queensland (Queensland Health) 2018 This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives Australia. In essence, you are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute Queensland Clinical guidelines , Queensland Health and abide by the licence terms. You may not alter or adapt the work in any way. To view a copy of this licence, visit For further information, contact Queensland Clinical guidelines , RBWH Post Office, Herston Qld 4029, email phone (07) 3131 6777. For permissions beyond the scope of this licence, contact: Intellectual Property Officer, Queensland Health, GPO Box 48, Brisbane Qld 4001, email phone (07) 3234 1479.

6 Queensland Clinical Guideline : Induction of labour Refer to online version, destroy printed copies after use Page 3 of 30 Flow Chart: Method of induction of labour Flowchart: Indication Maternal and/or fetal benefitContraindications As for vaginal birth Communication with woman Indication Maternal &/or fetal benefit & risk Individual circumstances Proposed IOL methods Options for pain management Options if:o IOL unsuccessfulo IOL declinedo Expectant management preferred Time for decision-making Obtain informed consent Document aboveMembrane sweep Discuss antenatally Offer prior to IOLB alloon catheterDinoprostoneOxytocinPre IOL assessment Review history Confirm gestation Baseline observations Abdominal palpation (presentation, attitude, position, lie, engagement) CTG: consult obstetrician if abnormal Vaginal examination: o Assess MBSo Membrane status (intact or ruptured)Induction of labourYesNoMembranes ruptured?

7 NoYesARM Previous CS?Refer to relevant flow chartIf IOL declined or postponed Consider individual circumstances, woman s preferences, local service capabilities and priorities Perform maternal and fetal assessment Arrange ongoing monitoring From 42+0 weeks offer twice weekly:o CTG o USS for fetal wellbeing Provide verbal and written information on fetal movement Advise to contact health care provider if concerned Document assessment and plan of care in the health recordMBS 7(favourable)NoYesModified Bishop Score (MBS)0123 Cervical dilatation (cm)< 11 23 4> 4 Cervical length (cm)> 321< 1 Station (ischial spines) 3 2 1/0+ 1 /+ 2 Cervical consistencyFirmMediumSoft-Cervical positionPosteriorMidAnterior-MethodeitherARM: Artificial rupture of membranes; cm: centimetres; CS: Caesarean section; CTG: Cardiotocography; IOL: Induction of labour; MBS: Modified Bishop Score; USS: Ultrasound scan; <: less than; >: greater than.

8 : greater than or equal to Queensland Clinical Guideline : Induction of labour Refer to online version, destroy printed copies after use Page 4 of 30 Flow Chart: Balloon catheter Flowchart: Indications MBS 6 Previous CS Following dinoprostone if no/minimal effect on cervical ripening and ARM not technically possible Reduced risk of uterine hyperstimulation is desirableContraindications Ruptured membranes Undiagnosed bleeding Simultaneous use of prostaglandins Low lying placenta Polyhydramnios Abnormal FHR auscultation or CTGR elative contraindications Antepartum bleeding Lower tract genital infection Fetal head not engaged (4/5 or 5/5 above pelvic brim Insertion procedure Pre catheter insertion:o Ensure pre IOL assessment completeo Encourage to empty bladder Performed by medical or midwifery staff.)

9 O Contact a more experienced clinician if two unsuccessful attempts Inflate balloon catheters with sterile water or sodium chloride:o Double balloon: 80 mL each balloono Single balloon: 30 80 mL Document inflation volumeInduction of labourSee flowchart: Method of inductionBalloon catheterLabour care (Birth Suite)Ongoing care as indicated12 hours after insertion:(Do not leave catheter in situ longer than 18 hours) Reassess in birth suite Recommend ARMNoContinue IOLR ecommend immediate commencement of oxytocinARM successful?Obstetric reviewConsider: Dinoprostone, or Reinsert catheter after 24 hoursYesNoPost procedure observation and care Pulse, BP, FHR, uterine activity, engagement of fetal head and vaginal losso Immediately, and repeat at 30 minuteso Medical review if malpresentation or fetal head 5/5 palpable after insertiono CTG not required (unless other indications) If observations normal, no contractions and not otherwise indicated, ongoing care as for latent first stage of labour Assess for/ask about discomfortModerate or severe discomfort?

10 Ongoingpain/ discomfort?Reduce balloon volume Remove 10 mL from each balloon Reassess and repeat to a minimum of 50 mL of residual volume in each balloon Document volume removedLabour commenced?Moderate or severe discomfort?If not in labour, offer analgesiaand sedationNoYesNoNoYesYesYesCatheter out?Observations abnormal?Labour commenced?SROM?as requiredany ofARM: Artificial rupture of membranes; BP: Blood pressure; CS: Caesarean section; CTG: Cardiotocography; FHR: Fetal heart rate; IOL: Induction of labour; MBS: Modified Bishop Score; mL: millilitre; SROM: Spontaneous rupture of membranes; : less than or equal to Queensland Clinical Guideline : Induction of labour Refer to online version, destroy printed copies after use Page 5 of 30 Flow Chart: Prostaglandin E2 (dinoprostone) Flowchart: Pre dinoprostone insertion Complete pre IOL assessment Encourage to empty bladderInduction of labourSee flowchart: Method of inductionARM successful?


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