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woman-centred induction of labour (the wocil project)

by:OPeREAL     2019-08-24
Induction of labor (IOL)
It is a common intervention in obstetrics.
In our maternity department, 32% of women are induced to labor each year.
Due to unit activity, long stay in hospital and complaints from staff and service users, we have encountered delays in launching IOLs.
We used quality improvements (QI)
Method to identify inefficiencies and root causes and use the bottom
Plan ways to improve.
After optimizing our artificial crystal process, we introduced the Micol vaginal insert (MVI)
Because it moves faster than the traditional noropro ketone.
We compared 207 women who received MVI and 172 women who took dinopro ketone before receiving MVI introduction.
The initial delivery time of the artificial crystal has been reduced from an average of 30 hours to 21 hours.
There are fewer women in need of labor promotion and fewer women in need of labor promotion.
We also found a decrease in the rate of caesarean section in women receiving artificial crystals, which was statistically significant in women who were not educated (41%–25%, p=0. 03).
The use of MVI has a higher rate of uterine rapid contraction and hyperstimulation, which should be accompanied by the education of employees when introduced.
We did not find an increase in neonatal admission, maternal bleeding, or other serious adverse events.
To sum up, MVI is a useful drug that can help large volume units increase the rate of artificial crystals, reduce bed occupancy and improve the flow of women.
We recommend the adoption of the overall QI approach for change management, as safe use of drugs requires optimization of the intraocular process and employee engagement, due to the rapid flow of women through the artificial crystal pathway and the increase in over-stimulation rates.
Summary of labor problems (IOL)
The UK\'s current rate is the highest ever, at 29. 4%-2017 2016.
This may be due to factors such as obesity, high blood pressure and high incidence of gestational diabetes and increased maternal age.
In addition, save the baby Life Care Package 3, which reduces the rate of stillbirth, will continue to increase the rate of artificial crystals.
The rate of artificial crystals in our unit, level 3
The level of regional referral centres for obstetrics and newborns has also risen, currently at 32%, giving birth to 5800 people per year.
We carried out process planning and held a series of staff participation activities.
We found that the artificial crystal booking process was not robust in the average allocated workload.
Outpatient artificial crystal intake rate is low. Frequent delays
May lead to adverse outcomes, such as sepsis at birth and Caesarean section (CS).
Setbacks for staff, women and partners. The Woman-
Centralized induction of labor (WOCIL)
The project hopes to reduce the time women spend in the hospital during the implantation of artificial crystals, making the experience more effective and more suitable for women.
We started this work in October 2016 and the project was initially approved to continue for 18 months.
Our main goal is to shorten the total length of stay in hospital by: the crystals begin shortly after a woman arrives at the unit.
Reduce the time it takes to go from the beginning of the artificial crystal to the delivery.
Increase the use of outpatient artificial crystals.
Background due to obstetrics culture and physician preferences, the practice of artificial crystals may vary greatly between countries and units.
4-6 focus of artificial crystals-
Related quality improvement (QI)
The items in the report literature are mainly divided into two categories --
Reduce \"inappropriate IOLs\" and \"selective delivery before 39 weeks\" 5. 7. 8 and 2, reducing inefficiency in the process of artificial crystals.
9 There is evidence that the following measures can be taken to achieve the above objectives:
Participation of multi-disciplinary staff in guideline development and staff education.
7-9 the process for booking IOLs is standardized.
5 7 8 provide continuous feedback to staff on project results and data.
In order to reduce costs and bed occupancy, 8-9 outpatient artificial crystals were used in obstetrics.
9 10 there is also evidence that it increases maternal satisfaction compared to in-hospital artificial lenses.
11 serious adverse events are low-
As a result, most studies do not have enough motivation to detect any potential safety issues compared to in-hospital artificial crystals.
Some cohort data showed no difference in severe maternal and fetal adverse outcomes.
The current national guidelines for outpatient artificial crystals provide that there should be sufficient \"safety and support procedures \".
There are two main types of drug methods for induction of labor: dinopro ketone (
Provided in a gel or tablet preparation, it is required to be administered 6 times per hour, and a slow release vaginal insert that releases the drug 24 hours a day)
And missool.
Two different modes of delivery can also be used with missool
Tablets for vagina or oral administration and vaginal inserts for slow release.
Compared to the dinuo pro ketone gel/tablet in a randomized controlled trial (RCT)
Placement, Yinuo pro ketone vaginal insert (DVI)
There is no difference in efficacy or delivery time.
15 however, the benefit of DVI is that less vaginal examination is required in women who need more than one dose of gel/tablet.
DVI has the potential to reduce total AI time in real time
Living environment, because the subsequent dose of gel/tablet depends on the time of midwifery.
9 with respect to missool, the UK National Guide states that it can only be used in the case of Fetal intrauterine death or in clinical trials.
14 when the guide is released (2008)
, The only preparation available for missool is the tablet, which needs to be divided into four quarters or eight months (
Depending on the system used)
Before oral or vaginal administration.
Technical issues to ensure accurate concentration and reliable drug delivery, as well as the facts used in artificial crystals
The permit, which means that, as recommended by the national guidelines, microsool in the form of tablets is rarely used in artificial crystals in the UK.
At the international level, oral or vaginal administration is a commonly used artificial crystal drug due to low drug cost and good room temperature stability.
The effect of missool in induction of labor is recognized.
It is an artificial crystal agent recommended by WHO and the International Federation of Obstetrics and Gynecology.
17 18In 2014, a Micol vaginal patch (MVI)
Get a UK license.
In a randomized controlled trial comparing the efficacy and safety of missol vaginal inserts, compared to DVI (MVI)
Compared with the Yinuo pro ketone vaginal insert (DVI)
Reduce vaginal delivery time (EXPEDITE)
In the trial, the interval between induction of labor in the MVI group was significantly shortened, and fewer women needed hormone production.
MVI increased the incidence of rapid uterine contraction and excessive uterine stimulation;
However, there is no difference between the mode of delivery and maternal or fetal adverse outcomes.
19 measurement we selected the following result measurement: the time from the beginning of the artificial crystal to the point of reach.
The time from the beginning of the artificial crystal to the delivery.
Percentage of women undergoing outpatient intraocular lens surgery.
Process measures include: the number of women who need hormone production.
The time from the start of labor to Labor.
In order to ensure that our interventions maintain good safety and ensure that women have access to labor pain relief, we collect data on the following balancing measures: Mode of Delivery (
Normal vagina, instrument or CS).
Number of women receiving labor pain relief.
Results of Neonatal Safety (
The number of infants requiring postpartum antibiotics, admitted to hospital for intensive care, umbilical cord pH
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