Induction and Augmentation of Labour Flashcards
What are the indications for Induction of Labour?
Uteroplacental insufficiency Prolonged gestation – 40-42 weeks PROM Maternal health problems – hypertension, pre-eclampsia, diabetes and obstetric cholestasis Foetal Growth Restriction Non-reassuring CTG Intrauterine foetal death Oligo or anhydramnios Chorioamnionitis Antepartum haemorrhage
What are the contraindications for Induction of Labour
CBD (cephalopelvic disproportion)
Vasa/Placenta Praevia (foetal blood vessels cross the internal os)
Cord Prolapse
Abnormal lie, especially Breech and transverse lie
Active primary genital herpes
Previous CLLASSICAL Caesarean section
Triplet or higher
2 or more low transfer caesarean sections
Must confirm a reassuring foetal heart prior to IOL
How can we predict whether an IOL will work or not?
Bishop’s score
> 9 suggest labour is likely to progress normally
>/= 7 suggests there is a high chance of IOL working
<5 suggests natural labour is unlikely to progress and prostaglandins will be required
Failure of cervix to ripen after prostaglandins may require a caesarean section.
Features assessed - Dilation, length, station, consistency and position.
If the Cervix fails to ripen after IOL what should be done?
Failure of cervix to ripen after prostaglandins may require a caesarean section.
What is a membrane sweep, when is it done and is it classed as IOL?
Offered at 40 and 41 weeks to nulliparous women and 41 weeks to multiparous women. It is not strictly speaking IOL but merely increases the likelihood of a spontaneous delivery. A gloved finger is passed through the cervix and rotates against the foetal membranes aiming to separate the chorionic membrane form the decidua.
How can a balloon catheter be used to induce Labour?
Balloon catheter – inserted above the cervix and tied to the mother’s leg. She is then free to go home as the catheter gently applies pressure onto the cervix encouraging it to open and dilatate. Either falls our or is removed after 24 hours.
How can Labour be induced pharmacologically?
Vaginal Prostaglandins (PGE2 = dinoprostone) – most common comes as a tablet or a gel. Tablet, 1 cycle = 1st dose plus a 2nd dose if labour has not started 6 hours later. Pessary, 1 cycle = 1 dose over 24 hours. Recommended only 1 cycle occurs per 24 hours.
What is an Amniotomy and how can it be used to stimulate Labour?
Artificial rupture of the membranes (ARM) using an amnihook. This process releases prostaglandins naturally. If after 2 hours there are no cervical changes then an infusion of artificial oxytocin (Syntocinon) is given to increase the strength and frequency of contractions.
What are the side effects and Risks of Syntocinon?
Side effects and risks of Sytoncinon
Headaches, nausea, vomiting
Maternal risks – uterine rupture, hyperstimulation, tachysystole (>6 contractions in 10mins), amniotic fluid emboli and haemorrhage
Foetal risks – asphyxia and foetal distress
What are the complications of IOL
Failure Uterine hyperstimulation and so foetal distress Cord prolapses Infection Pain – often more painful Uterine rupture: 5:1000 with spontaneous labour 8:1000 with use of oxytocin 24:1000 with prostaglandins
What is uterine hyperstimulation and how should it be treated?
Uterine hyperstimulation = contraction lasting longer than 2 minutes or more than 5 in 10minutes. Treat with tocolytics e.g. terbutaline.
