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)
