Inducing Labour Flashcards
When is induction of labour contraindicated?
Absolute: Acute foetal compromise Placenta previa Unstable lie Pelvic obstruction
Relative: Previous caesarean Prematurity High parity Breech presentation
What are the indications for the induction of labour?
Preeclampsia Prolonged pregnancy (>42 weeks) Intrauterine growth restriction Diabetes Chronic renal disease Poor obstetric history Antepartum haemorrhage due to placental abruption or of uncertain origin
What is membrane sweeping?
Prior to the induction of labour, a finger is used to separate the membrane from the lower segment of the uterus
This releases prostaglandins to efface/dilate the cervix
The mother should then go into labour within 72hours
What score is used to assess the likely outcome of the induction of labour?
Bishops score
What are surgical methods of inducing labour
Artificial rupture of membranes- releases local prostaglandins. If no regular, painful contractions or cervical changes after two hours, commence oxytocin infusion
What are medical methods of inducing labour?
Prostaglandin pessary:
Perform CTG 30mins before and after insertion of prostaglandins. Repeat if necessary every six hours.
Syntocinon infusion:
Low dose doubles every 30mins. Use continuous CTG monitoring
What are the complications of inducing labour?
Foetal distress- increased frequency of contractions leads to reduced oxygenation of baby
Precipitate delivery- too fast delivery!
Uterine hypotonia with rupture
Amniotic fluid embolus
Systemic effects
What factors does the bishops score take into account
takes into account the consistency, position, dilatation, length and station of the presenting part
What score on the bishops score in favourable?
Greater than seven- favourable cervix for induction
Less than seven- use cervical ripening techniques such as the membrane sweep
What is syntocinon?
Synthetic version of oxcytocin
What is the difference between misoprostol and Prostin
Misoprostol - PGE1
Prostin - PGE 2
Should misoprostol be used in the induction of labour?
No - only if for a termination/ still birth
What is the risk of artificial rupture of membranes?
Cord prolapse
What is the max dose of prostaglandin 2?
6mg/day
What equipment is used in an ARM?
Amniohook
