The RCOG Scientific Impact Paper ‘Induction of labour at term in older mothers’ advice this line of management given the multiple adverse maternal and fetal outcomes associated with rising maternal age. IOL at term is not uniform practise across all units. This audit looked into our local management of women 40 years and over.
290 women 40 years and over delivered at Epsom and St Helier’s Hospital in 2012 (5% of deliveries).
No women were referred to an Obstetrician antenatally as high risk due to age alone and in only 2 cases was IOL at term discussed.
Maternal age alone was not the sole indication for any IOL. The most common indicator for IOL was post-dates. The rate of IOL of 18% is comparable to the Trust IOL rate (19%).
51% of women 40 years and over had spontaneous onset of labour, however 25% delivered by emergency caesarean section (Trust 17.8%) regardless of type of onset of labour and 20% delivered by planned caesarean section (Trust 9.3%).
FindingsThis audit did not find that IOL at term for older mothers was routine clinical practise. The audit raises the issue of streamlining the management for these women due to higher rate of intervention. We aim to develop a care pathway for the management of pregnancies in women aged 40 years and over and audit obstetric and neonatal outcomes for IOL at term for maternal age alone over a set time period.
Reference Induction of Labour at Term in Older Mothers. Scientific Impact Paper No. 34 RCOG. February 2013