Inducing Labour NICE Flashcards
What % of babies deliver before 37 weeks?
7.7%
What % of babies delivery by 39 weeks?
25%
What % deliver by 40 weeks?
50%
What % deliver by 41 weeks?
83%
What % deliver by 42 weeks?
99%
Risks of pregnancy beyond 41 weeks
- Risk of CS
- Risk of baby attending NNU
- Stillbirth and neonatal death
IOL from 41 weeks may reduced these rusks
Risk of stillbirth in White, Asian and black babies, as per 2020 MBRRACE
Per 10,000
White 34
Asian 53
Black 74
What additional monitoring should be offered from 42 weeks
2 x weekly CTG
USS amniotic fluid
explained does not predict risk
Timing of IOL PPROM
GBS 34 weeks
No GBS/compromise 37 week
What to offer women with PROM
Expectant mgmt 24 hrs
IOL asap (if GBS IOL immediately)
IOL with previous CS
Increased risk of EMCS and uterine rupture
Can offer mechanical method, hormonal dinoprostine/miso is contraindicated
Should offer IOL or ELCS
Breech and IOL
Not generally recommended
Unless birth needs to be expedited, ECV refused/unsuccessful and declines CS
If FGR?
No not induce FGR with confirmed fetal compromise, offer CS
IOL precipitated labour
Do not offer, risk birth unattended by healthcare professional
Non scarred uterus, intrauterine fetal death
Mife 200mg, followed by miso
or
mechanical IOL
Scarred uterus, intrauterine fetal death
Discuss risk uterine rupture
?Mechanical
When can membrane sweeps be offered?
From 39 weeks
What should warn risks of IOL
Risk hyper stimulation - will remove hormone +/- tocolysis
Bishop score
If Bishop score <6 what should be offered
IOL with hormones - dinoprostone as tablet, gel or delivery system or 25mcg misoporstol
or
Mechanical methods
If bishop score >6, what IOL should be offered
Amniotomy and oxytocin infusion
Assessment before induction
Abdo exam
Bedside USS
Bishop scopre
FH on CTG
?Uterine contractions
Who can be offered outpatient IOL with hormones/mechanical
No obstetric or medical concerns
Safety netting
What to do hyper stimulation
Fetal assessment
DO not give further IOL, remove vaginal pessary/delivery system
Consider tocolysis
What to offered failed IOL
Rest than re-assess
Expectant Mgmt
Further attempts
CS
How to avoid cord prolapse
Assess station of head
Feel for cord during VE
Cont CTG after cords reptured
If suspect uterine rupture
Cat 1 EMCS
