Induction and Augmentation of Labour Flashcards
What is a trial of scar?
A vaginal birth with a history of caesarean
What are some methods of inducing labour?
Prostin E2 gel - softens and partly dilates the cervix
Amniotomy
Syntocinon
When is prostaglandin gel contraindicated? What are the risks?
Previous caesarean
Uterine rupture
What is an amniotomy?
Artificial breaking of the water with forceps via vaginal exam
When don’t you do a amniotomy? Why?
When the head is not well applied to the cervix
Due to risk of cord prolapse
What is syntocinon?
A posterior pituitary polypeptide that stimulates uterine muscle contraction
What are some side effects of syntocinon?
Uterine hyperstimulation with subsequent fetal distress
Nausea, vomiting, hyponatraemia
What are some side effects of IOL?
Cord prolapse
Uterine hyperstimulation
Fetal distress
Precipitant labour
What percentage of induced labour fail? What do you do if it happens?
10%
Caesarean
What is the purpose of instrumental delivery?
Facilitate or expedite vaginal delivery
What the instruments used?
Nevile Barnes or Kielland’s forceps
Ventouse vacuum device
What are Kielland’s forceps used for?
Rotation of the head
At what levels of engagement can you instrument?
Mid
Low
Outlet
Why do an instrumental delivery?
Delay in second stage of labour - Maternal exhaustion - Excessively effective epidural - Malposition of presenting part Fetal distress in second stage of labour
What is the Franken-Hause plexus?
Plexus of nerve in the rectum that the baby’s head pressures stimulating contraction
What is required for an instrumental delivery?
Second stage of labour (full dilation) Fetal head should be engaged Cephalic position Adequate analgesia - epi, spinal, pudendal Lithotomy position (stirrups) Catheter passed Appropriate resuscitation facilities Episiotomy - especially if forceps
Which type of instrumentation requires a episiotomy?
Forceps (due to added diameter with forceps)
When do you use each type of instrument?
Neville Barnes forceps for anterior positions
Ventouse for anterior or rotation from lateral or posterior and delivery
When do you instrument in theatre?
When you’re not sure that it will work
What are some complications of instrumentation?
Bruising
Facial nerve palsy
Intracerebral bleeding
Damage to cervical spine
Chignon and circular bruise
Subaponeurotic bleeding or intracerebral bleeding
Soft tissue tears and bruising to vagina and perineum
