Induction and Augmentation Flashcards
What are some indications for induction of labour?
- Postmaturity by 10-14 days
- Hypertensive disease/pre-eclampsia
- Diabetes
- Ruptured membranes/chorioamnionitis
- Foetal growth restriction
- Foetal compromise
- Autoimmunisation
- Placental abruption
- Twin pregnancy
- Foetal death in utero
- Termination of pregnancy
- Poor past obstetric history
- Social
What are absolute contraindications to induction of labour?
- Breech presentation/transverse lie
- Placenta praevia
- Active genital herpes
- Cord presentation/prolapse
What are the relative contraindications to inducing labour?
- Prematurity
- Foetal growth restriction (consider CS)
- Foetal compromise (consider CS)
- Previous CS
- Significant cephalopelvic disproportion
What are the methods used to induce labour?
- Membrane stripping
- Prostin E2
- Balloon catheter
- Misoprostil
- ARM
- Syntocinon
What score is used to predict whether induction of labour will be necessary? What comprises it?
- Bishop score
- Cervical dilation
- Length of cervix
- Station of presenting part
- Consistency of cervix
- Position
What are the advantages and disadvantages of using prostin E2 when considering induction of labour? Contraindications?
- It’s usually used to soften cervix so ARM can be performed, but often causes spontaneous IOL
- May induce uterine hyperstimulation, foetal distress (needs CTG monitoring)
- Uterine scar, ruptured membranes, foetal compromise
What are the advantages and disadvantages of using a balloon catheter when considering induction of labour?
- No risk of uterine hyperstimulation
- Slow
Why would you perform an amniotomy? What are the risks?
- To induce or augment (most common use for this) labour. Requires a dilated cervix
- Risk of cord prolapse if presenting part not well applied (multis, polyhydramnios). Infection, occult praevias
Why would you use syntocinon? What are the benefits and risks?
- Induction of labour (generally in conjunction with prostin and ARM) via titrated IV infusion
- Short half-life
- Uterine hyperstimulation (CTG required), N/V, water intoxication, hyponatraemia (VP cross-reactivity), hypotension (only if rapidly injected)
What are the indications for an instrumental delivery? The contraindications?
- Delay in the second stage of labour (exhaustion, effective epidural, malposition)
- Foetal distress in second stage of labour
- Delivery of the aftercoming head of a breech
- Maternal effort contraindicated
Contraindications
- Foetal bleeding disorders, foetal fracture predisposition, vertical HCV transmission face presentation (ventouse only)
What is required for a successful instrumental vaginal delivery?
- Experience with instruments
- Fully dilated cervix
- Cephalic presentation and head engaged with position known
- Appropriate analgesia
- Lithotomy position
- Catheter passed and bladder empty
- Appropriate neonatal resuscitation facilities on standby
- Consideration of episiotomy
- If no previous successful vaginal delivery, best performed in theatre with option to continue to CS
What are the common instruments used to deliver a baby? When are they commonly used?
- Forceps - delivery more likely with these but increased maternal morbidity
- Neville-Barnes - used for anterior head positions
- Kielland’s - used to rotate posterior head positions to anterior
- Abandon if no evidence of progressive descent OR delivery not effected after 3 pulls
- Ventouse vacuum device - anterior delivery or to rotate to anterior position
- Increased foetal morbidity - attempt forceps first
What are the risks to mother and baby of an instrumental delivery?
- Mother
- Soft tissue tears and bruising to vagina and perineum
- Baby
- Superficial bruising, facial nerve palsy, intracerebral bleeding, damage to C-spine, shoulder dystocia
