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RGU 2 > Induction: Indication & Methods > Flashcards

Induction: Indication & Methods Flashcards

1
Q

What is induction?

A
  • stimulation of uterine contractions to accomplish delivery PRIOR to the onset of spontaneous labor.
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2
Q

What is augmentation?

A
  • treatment of abnormal labor (i.e. contractions/labor is present).
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3
Q

What are the indications for induction?

A
  • OBSTETRICAL and MEDICAL induction= delivery before the onset of labor is indicated, when the maternal/fetal risks associated with continuing the pregnancy are thought to be greater than the maternal/fetal risks associated with an early delivery.
  • ELECTIVE at term= induction at patient request (no longer before 39 weeks).
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4
Q

What are the obstetrical and medical indications?

A
  • post-term pregnancy
  • premature rupture of membranes (PROM)
  • preeclampsia, eclampsia, HELLP syndrome
  • fetal demise
  • maternal diabetes
  • fetal growth restriction
  • twins
  • abruptio placentae
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5
Q

What are the contraindications of induction?

A
  • prior high risk cesarean incision.
  • prior uterine rupture
  • prior transmural uterine incision entering the uterine cavity.
  • active genital herpes infection.
  • placenta previa or vasa previa
  • umbilical cord prolapse or persistent funic presentation
  • transverse fetal lie
  • invasive cervical cancer
  • category III fetal heart rate tracing
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6
Q

What is the problem with elective induction at term?

A
  • COST to health care! EXPENSIVE
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7
Q

What things must we assess when considering induction?

A
  • gestational age (at least 39 weeks)
  • fetal weight (4500 g in DM or 5000 g in non-diabetic moms).
  • presentation (vasa previa…)
  • cervical assessment
  • fetal heart rate pattern
  • review of pregnancy and medical hx
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8
Q

How do we confirm term gestation?

A
  • US at less than 20 weeks gestation supports gestational age of 39 weeks or greater.
  • fetal heart tones present for 30 weeks by doppler US.
  • it has been 36 weeks since a positive serum or urine hCG result
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9
Q

What criteria must be met to confirm gestational date with US?

A
  • consistent if within 5 days by crown-rump length (CRL) if obtained at 6-14 weeks (1st trimester).
  • within 7 days if obtained at 14-20 weeks gestation (2nd trimester)
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10
Q

Does mean diameter of gestational sac help in determining gestational age?

A

NO

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11
Q

*** What is the gestational week terminology for preterm, term or post term?

A
  • preterm= 20-37 weeks
  • term= 39- 41 weeks (BEST TIME TO DELIVER)
  • post term= after 41 and 6/7 weeks
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12
Q

*** What is late preterm?

A
  • 34-37 weeks
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13
Q

*** What is early term?

A
  • 37-39 weeks

* we don’t encourage early labor induction here anymore.

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14
Q

How much does fetal brain cortex volume increase between 34 and 40 weeks gestation?

A

50%

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15
Q

Must the cervix be ripened before we induce labor?

A

YES

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16
Q

How do we know if the cervix is ripened?

A

Bishop scoring system:

  • dilation
  • effacement
  • station (where the leading edge of skull is located in relation to the ischial spines).
  • cervical consistency
  • position of cervix
  • based on -3 to +3 scale
17
Q

What is considered a good score to induce labor using the Bishop scoring system?

A
  • 5 or higher
18
Q

What are some home remedies for induction?

A
  • castor oil
  • black cohosh
  • pirmrose oil
  • acupuncture
  • sex
  • walking
19
Q

What happens with cervical ripening?

A
  • collagen breakdown leading to weaker and softer stroma.

- increase in prostaglandins

20
Q

What prostaglandins are used for cervical ripening?

A
  • Misoprostol (prostaglandin E1)= not FDA approved for labor induction or cervical ripening, but CHEAP.
  • higher rate of vaginal delivery w/o need for oxytocin.
  • Cerividil and Prepidil (prostaglandin E2)= more expensive
  • higher rate of need for oxytocin and tachysytole.
21
Q

What are 2 mechanical methods for cervical ripening?

A
  1. cook catheter
  2. foley catheter
    * low cost, removable, and easy to use, but possible risk of infection.
22
Q

If we already have a ripe cervix, how then can we proceed with induction?

A
  • oxytocin
  • membrane stripping
  • amniotomy
  • prostaglandins
23
Q

What are the 2 protocols for oxytocin use?

A
  • LOW DOSE protocol= start at 1-2 munits/min and increase by 1-2 munits/min every 115-40 minutes.
  • HIGH DOSE protocol= start at 6 munits/min and increase by 3-6 munits/min every 15-40 minutes (not done as much).
  • remember this is given at a rate to mimic the pulsatile fashion of the pituitary. Reaches steady state at 40 mins and half-life is 1-6 mins (don’t exceed 40 munits/ml).
24
Q

What are the advantages of oxytocin?

A
  • cheap, easy to titrate, easily reversible (since it has a short half life) and it is bioidentical to natural oxytocin in the body.
25
Q

What are some disadvantages of oxytocin?

A
  • one of the most potent uterotonic agents known.
  • uterine tachysystole/hyperstimulation
  • uterine rupture
  • amniotic fluid embolism
  • hyponatremia, pulmonary edema and generalized edema (due to similarity to ADH/vasopressin).

RGU 2 (24 decks)

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