5.2 Induction of Labour Flashcards
Define induction of labour
Artificial stimulation of uterine contractions before the spontaneous onset of labour
What is the definition of unstable lie?
Lie of foetus constantly changing hence unstable. indications of such are transverse, oblique and breech
Give 8 indications of induction:
Give 4 contraindications:
When the risk of continuing pregnancy > risk of induction itself
Maternal:
1) Pre-eclampsia
2) Diabetes
3) APH
4) Poor past obstetric history
Foetal:
1) Post-term -> >42 week (big)
2) PROM (small)
3) Multiple births (big)
4) IUGR (small)
5) Foetal death (gone)
Contraindications:
1) Malpresentation (Brow/Face)
2) Unstable lie (breech, transverse, oblique)
3) Cephalo-pelvic Disproportion
4) Placenta Previa (even low lying)
5) Low-lying fibroid
Do fibroids cause pain?
No they do not, it is their necrosis that would cause pain
State all the method of induction in increasing order of effectiveness
Cervical sweep
Foley Catheter balloon
AROM via amnihook
Oxytocin/syntocinon
Propes/Prostin = PGE2
What method of induction is administered if Bishop score is 7
Score >7 = Favourable for induction => likely to succeed => AROM + Oxytocin
What method of induction is administered if Bishop score is 6
Score 6 or less = Unfavourable for induction, vaginal prostaglandins (PGE2) may be necessary.
Induction is carried out in anticipation that the patient will have a vaginal delivery. How would you decide which method of induction to administer?
Bishop’s score:
As term approaches, 5 things occur
1) a) Cervix shortens + b) becomes softer
2) Cervical Dilatation as the presenting part puts on more pressure
3) Position of the CERVIX moves anteriorly
4) Station: Station reduces
Score 7+ = Favourable for induction => likely to succeed => AROM + Oxytocin/Syntocinon
Score 6 or less = Unfavourable for induction, vaginal prostaglandins (PGE2) may be necessary.
Define station
Lowest point of foetal head, in cm, relation to ischial spines
Where is oxytocin produced?
Posterior pituitary
Most women after AROM can deliver without induction. What is an important to ensure before performing AROM? (2)
1) Rule out placenta praevia on ultrasound on form previous notes confirming location of placenta
2) The head should be well applied on the cervix to prevent core prolapse
How is syntocinon administered?
Give 2 Side-effects of syntocinon infusion induction
Can be administered IM for placental delivery and initially to prevent PPH as well as to deliver the placenta
For induction and later in PPH, you would administer it IV infused in normal saline
Side effects:
1) Hyperstimulation -> Uterine rupture
2) fluid overload -> Pulmonary oedema/generalized oedema
When inducing a patient what is the target contractions/10 minutes
What would be considered dangerous?
4 in 10 is the target
5 in 15 is a risk of tocosystole -> hyperstimulation -> uterine rupture
State 4 complications of induction
1) Cord prolapse
2) Hyperstimulation/rupture
3) Non-reassuring CTG
4) Prolonged labour causing increased risk of PPH and operative delivery
5) Failure -> emergency C-section
Is prostaglandin allowed to be administered in VBAC? (vaginal birth after C-section)?
It is contraindicated unless the mother does not consent to C-section and senior input allows this.
