Induction and Augmentation of Labour Flashcards
What is induction of labour cf augmentation?
The process of causing labour to commence (and continue); augmentation is the process of stimulating a labour already commenced
What must be considered in deciding to induce labour?
The risks of continuing the pregnancy cf those of interrupting the pregnancy
What are the reasons to induce labour?
- Post maturity: EDD +10d
- HTN /PEt
- DM
- ROM / chorioamnionitis
- IUGR
- Foetal compromise
- Blood group isoimmunisation
- Abruption
- Twin pregnancy
- FDIU
- TOP
- Social
What are reasons not to IOL?
- Prematurity
- IUGR*
- Foetal compromise *
- Breech / transverse lie
- Praevia
- Previous LUSCS
- Cephalopelvic disproportion
- may be better delivered via LUSCS
What are the methods to induce labour?
- Prostin E2
- ARM
- Syntocinon
May require 1, 2 or all to achieve IOL
What is the role of pristine?
Prostaglandin E2 used to ripen the cervix: soften and partially dilate to allow ARM
What are the risks of prostin?
May cause uterine hyper stimulation with:
- foetal distress
- precipitate labour
- uterine rupture
When should prostin be avoided?
- Previous uterine scar
- Ruptured membranes
What is required during prostin administration?
CTG monitoring before and after administration
What is ARM?
Small hook or forcep used to rupture the forewaters
What must be considered when performing ARM?
Bewared cord prolapse if presenting part not well applied
What is syntocinon?
Posterior pituitary polypeptide which stimulated uterine muscle contraction
Risks of syntocinon?
- Uterine hyper stimulation with foetal distress (need CTG) Side effects: - Nausea - Vomiting - Water intoxication - Hyponatremia
What are the complications of IOL?
- Cord prolapse (poorly applied presenting part)
- Uterine hyperstimulation (rupture, precipitate delivery) with PE2 or syntocinon
- Foetal distress
- Process may fail
What is the role of instrumental delivery?
Facilitate or expedite vaginal delivery
- Foreceps
- Ventouse Vacuum
When should instrumental delivery be considered?
- Delay in 2nd stage of labour:
- maternal exhaustion
- effective epidural
- malposition of presenting part - Foetal distress in second stage necessitating expedition of delivery
What is appropriate analgesia for an instrumental delivery?
- Epidural
- Spinal
- GA
- Pudendal block with perineal infiltration of local
What is required for an instrumental delivery?
- Experience with instrument
- Cervix fully dilated
- Foetal head engage
- Cephalic
- Analgesia
- Lithotomy
- Catheter (bladder empty)
- Resuscitation for baby
- May need episiotomy
What is the role of Neville Barnes forceps?
For anterior positions of foetal head
What are Keilland’s forceps used for?
To rotate the posterior position head to an anterior position; then apply NB forceps for delivery from anterior position
What may the ventouse vacuum be used for?
Delivery from anterior position; or to rotate to anterior with subsequent delivery
What are the complications of forceps delivery?
Excessive force or incorrect application may cause:
- bruising
- facial nerve palsy
- damage to C spine
- intracerebral bleed
What are the complications of Ventouse?
- Temporary chignon
- Circular bruise
May cause: - Subaponeurotic bleeding
- Intracerebral bleeding
What are the maternal complications of instrumental delivery?
Soft tissue tears and bruising to vagina and perineum
