Induction and instrumental delivery Flashcards
What gestational age is the legal definition of foetal viability in the UK
over 24 weeks
Foetal reasons for induction
- IUGR
- Rhesus incompatibility
- recurrent reduced foetal movements
- post maturity
- Intra-uterine death
- previous stillbirth
Maternal reasons for induction
- maternal age
- hypertensive disorders
- diabetes
- obstetric cholestasis
- recurrent antepartum haemorrhage
- symphysis pubis dysfunction
- on medication for VTE
- maternal request
Contraindications to induction
- major placenta previa
- transverse/oblique foetal lie
- previous vertical C section
- active genital herpes
- HIV (depends on viral load)
List 4 different methods of induction
- Membrane sweep
- Prostaglandin E2
- Amniotomy
- IV oxytocin
After what gestational age is membrane sweep performed
After 40w (can only do if cervix is dilated)
How does a membrane sweep work to induce pregnancy
Stripping membranes causes
o increase in release of prostaglandins & phospholipase activity
o mechanical dilation of cervix which release prostaglandins
Components of bishop score
- dilation
- cervix length
- cervix hardness
- cervix position (more anterior is good)
- station of baby’s head
What does a higher bishop score indicate
Good - means cervix is more ripe
Why must amniotomy be performed before starting IV infusion of oxytocin
Otherwise, risk of amniotic fluid going into mother’s bloodsteam
Risks of induction before labour
- increased analgesia use
- failure leading to C section
- uterine hyperstimulation
Risks of induction during labour
- foetal compromise
- cord prolapse
- uterine rupture
- intrauterine infection
- precipitate dysfunctional labour
- increased risk of operative vaginal delivery
Risks of induction after labour
Post partum haemorrhage
When are non rotational forceps used
In babies who are already facing occipital-anterior position
2 different types of instrumental delivery
- ventouse (preferred)
2. forceps (rotational and non-rotational)
Indications for instrumental delivery
- Prolonged second stage (maternal exhaustion)
- Foetal compromise
- Prophylaxis: cardiac/ retinal detachment/ hypertension
- Breech
Does ventouse or forceps have a greater failure rate
Ventouse (cup can fail if placed incorrectly)
Maternal complications of ventouse and forceps
- Vaginal lacerations
- Postpartum haemorrhage
- 3rd degree tears
Foetal complications of ventouse delivery
- Chignon (temporary swelling on head)
- Scalp lacerations
- Cephalhaematoma (bleeding between skull & periosteum)
- Neonatal jaundice
Foetal complications of forceps delivery
- Facial bruising
- Facial nerve damage
- Skull & neck fractures
Type of anaesthesia given for low cavity instrumental delivery (head well below ischial spines)
Pudendal block
Local anaesthesia
Type of anaesthesia given for low cavity instrumental delivery (head at ischial spines)
Epidural
Spinal anaesthsia
