Induction and Augmentation of Labour Flashcards
What is required for a woman’s pregnancy to continue, in relation to her cervix and uterus?
Her cervix to remain closed and rigid
Her uterus to remain quiet and not contracting
What triggers labour?
Hormones?
Foetus?
Mechanical?
What is induction of labour?
The artificial initiation of labour
What is augmentation of labour?
Progress of labour is enhanced by administration of oxytocin.
What maternal risk factors could lead to an induction?
Prolonged pregnancy Hypertension Diabetes Pre-labour rupture of membranes Maternal request - tokophobia (NICE suggests that social inductions can be considered if the Bishop score is favourable) PET OC SROM Age IVF (associated with placental insufficiency PD so induced once at term)
What foetal risk factors could lead to an induction?
IUGR
Fetal death
Fetal anomaly not compatible with life
Rhesus disease (intrauterine transfusion → early delivery)
Macrosomia with no other indication is not an induction for IOL
Poor dopplers
Oligohydramnios
Polyhydramnios
Persistent abnormally frantic foetal movements
Haematological problem
Cardiac problem
What other risk factors could lead to an induction?
Obstetric history- precipitate labour, previous IUD, infertility, previous large baby
Litigation fear
Hyperemesis
Social
What is the difference between post maturity and prolonged pregnancy?
Post maturity describes a particular clinical syndrome, pathologically prolonged pregnancy > 42 wks
What risks are associated with induction?
Hyper stimulation
Failed induction
Labour may be less efficient
An induced labour is generally more painful than spontaneous labour
More likely to require epidural analgesia
More likely to require assisted birth
Fewer than 2/3rds of women gave birth without further intervention
Ruptured uterus and possible maternal death
Fetal hypoxia and possible fetal death
Fluid overload – cardiac arrest or pulmonary oedema (oxytocin causes fluid retention, together with 100s mls saline could cause this)
When can an ARM be used?
ARM may be used for augmentation of labour or IOL +/- oxytocin, usually only done with a bishops score of > 7
The Cochraine review revealed that…?
Compared to amniotomy alone, amniotomy and oxytocin…
Resulted in fewer women still labouring by 24hrs
Resulted in fewer women needing instrumental deliveries
Led to more PPH
What are cervical ripening balloons?
Inserted into cervix and blown up to put pressure on cervix as foetal head would (potentially dangerous as no evidence to suggest how much pressure is too much, could lead to uterine rupture). Increased likelihood of achieving delivery within 24hrs. Negatives included a increased use of oxytocin and epidural
What are the side effects of a propess?
Can cause hypercontractility or hyperstimulation which may lead to abnormal FHR changes, fetal distress or in very severe cases uterine rupture.
Can cause gastric disturbances including nausea, vomiting and diarrhoea.
What are the side effects of prostin?
Can cause hypercontractility or hyperstimulation which may lead to abnormal FHR changes, fetal distress or in very severe cases uterine rupture.
Can cause gastric disturbances including nausea, vomiting and diarrhoea.
Often cause irritation/pain and warmness/dryness/soreness in the vagina
Contraindications- less than 34 weeks, asthmatic
Placing prostin in cervix and not posterior fornix can cause uterine rupture
What are the side effects of syntocinon?
Hyper contractility or hyper stimulation- can lead to abnormal FHR changes, foetal distress or in very cases uterine rupture or placental abruption
Should not be given within 6hrs of prostaglandin administration, potentiating effects
Water intoxicfication; slightly antidiuretic effect + excessive IV fluids could in extreme cases result in pulmonary oedema
Gastric disturbances, headache and tachycardia
Contraindications: cardiac conditions, unruptured membranes
