We conducted a national survey of consultants in Wales to elicit the opinions on induction of labour in women with a previous caesarean section. A total of 65 of the 87 consultants returned the postal questionnaire (75% response rate) and 54 of them were practising obstetricians. All but one obstetrician (53/54) would consider induction and for post-term indication, 47/53 would offer induction to a woman with a previous section; 40/53 (75%) of obstetricians would consider the prostaglandin method. The majority (36/40) would use prostaglandin tablets/gel; 80% (29/36) would use up to 2 doses (maximum recommended) and two-thirds (36/54) would consider syntocinon for augmentation of labour. A total of 34/54 (63%) consultants felt that Bishop's score would influence their decision to offer induction of labour (IOL) in a woman with one previous section and some 88% (47/53) of obstetricians always mentioned the increased risk of caesarean section and uterine rupture to these women during counselling before offer of induction. In conclusion, our survey reveals the variation in approach to management of postdates in women with previous caesarean section. We recommend a national audit of induction of labour in women with previous caesarean section.

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We conducted a pilot study on 60 women in the second stage of labour using trans-abdominal ultrasound to assess fetal position prior to obstetric intervention. Digital examination failed to assess the correct fetal position in 16 (26%) of the cases. Ultrasound helped in determining fetal position in 57 (95%) of the cases. In 40 cases (66%), the obstetrician involved found the use of ultrasound to determine fetal position aided in the management of the second stage. All obstetricians involved in the study rated the ease of use of ultrasound in the second stage highly (>8/10) on a visual analogue scale. We have highlighted the role, ease of use and feasibility of intra-partum ultrasound to determine fetal position in the second stage of labour before an obstetric intervention, by the obstetrician in a District General Hospital setting.

INTRODUCTION: Pregnant women with pre-existing diabetes have increased risk for poor outcomes such as macrosomia, shoulder dystocia, still birth and intrapartum interventions. The Combined Diabetes Antenatal Clinic (CDAC) in Prince Albert (started in 2012) is a multidisciplinary clinic that serves rural northern Saskatchewan where the prevalence of diabetes in pregnancy is high. The goals of the CDAC are to improve euglycemia and pregnancy outcomes. METHODS: Retrospective cohort chart review to quantify the reduction in HbA1c after CDAC interventions and if the reduction in HbA1c improved pregnancy outcomes. Ethics approval was obtained from University of Saskatchewan. RESULTS: We identified 116 CDAC patients with pre-existing diabetes between 2012-2017. Majority of the population (52%) had to travel over 200 km to reach the CDAC clinic. There were high rates of obesity (71%) and high parity (28% Para 4 or more), majority were Type 2 diabetics and 87% of mothers were on insulin at the time of delivery. Women often (75%) presented to the CDAC after the first trimester. However, over 50% of patients who attended the CDAC reached the target of having an HbA1c below 6.5% prior to delivery. Mean change in HbA1c was -1.0% (SD 0.5-2.4) Mothers with HbA1c below 6.5% at the time of delivery had lower rates of shoulder dystocia (5.9% vs 2.3%) and still birth (11.8% vs 4.5%). CONCLUSION: The CDAC is effective in reducing the HbA1c and reductions below 6.5% is associated with improved pregnancy outcomes. We advocate pre-pregnancy counselling and booking early in pregnancy for pre-existing diabetes in this rural population