Background Propess is a controlled release pessary which releases 0.3 mg of Dinoprostone per hour. As there is constant release rate, this would ensure steady Progesterone concentration and reduce the risk of hyperstimulation. Also, the need for one vaginal examination as opposed to one every 6 hrs improves patient acceptability.
Aim The aim of the audit was to look at the practise of using the first Propess on an out-patient basis with informed consent. We looked at the pregnancy outcomes after the Outpatient use of first Propess.
Method Prospective audit was done looking at the practise of using the first Propess.
Only low risk patients were given an option for Out-patient Propess. Informed verbal consent was obtained and open access to ward was given after Propess insertion. If anyone needed any further Propess, this was carried out as an in-patient. Initial proforma was filled in by the midwife and the notes were reviewed after delivery.
67% of women who laboured with Propess alone were Nulliparous
There were no adverse outcomes.
APGARs at 5 min were >9 for all babies
No admissions to neonatal unit
Avg. blood loss at delivery 388 ml
Results We looked the patients between the time period of 15/5/10 to 31/12/10. 57 women opted for Out-patient management.
Conclusion Outpatient use of first Propess does not alter pregnancy outcomes and does not increase the risks to baby.
When used selectively, the out-patient IOL is safe and effective alternative to patient admission.
Out patient use of Propess has decreased hospital stay.
20/57 women did not need a review prior to 24 hrs equalling 480 hours of saved in-patient care.
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