Induction of labour Flashcards
What 3 things are used for cervical ripening?
- Prostin
- Cervidil
- Balloon Catheters
When is an IOL usually recommended for ‘prolonged pregnancy’?
41+0 - 42+0
When is an IOL recommended for PROM (at term) for GBS neg/unknown
Within 24hrs
When is IOL recommended for GBS+, mec liquor and suspected sepsis?
Immediately.
What is the risk of IOL with someone who has had a previous C/S?
Increased risk of uterine rupture and emergency C/S
Is an IOL recommended for suspected fetal macrosomnia?
NO.
For a woman with a BMI >50 delivery is recommended at …….
38-39 weeks. Due to the presence of co-morbidities.
What method of IOL is recommended for someone with a risk of uterine scar rupture?
Balloon catheter, rather than prostaglandins or oxytocin.
Is AMA a reason for or against having an IOL?
Against. There is an increased risk of perinatal mortality in women over 35yrs.
What are some reasons for IOL?
- abnormal CTG or USS
- Fetal growth restriction
- decreases fetal movements
- APH
- FDIU
- HTN
- GDM
- hx of stillbirth
- maternal health reasons
When is IOL contraindicated?
- malpresentation
- previous C/S
- cord presentation
- placenta praevia or vasa praevia
- primary genital herpes
- cervical carcinoma
What does the Bishop score need to be for Prostin to be used?
<5
TRUE/FALSE: ARM, oxytocin can be commenced after Prostin.
FALSE. Need to wait 6hrs for oxytocin and 4hrs for ARM.
What is the 3rd stage management for IOLs started with Prostin?
Active.
Where is Prostin inserted?
posterior fornix of vagina. Not in cervical canal!
Can Dinoprostone (Cervidil) be inserted into the cervical canal?
No. High into the posterior vaginal fornix with a small amount of lubricant.
When does Cervidil tape need to be removed?
- SROM
- regular painful contractions every 3 mins
- ADR - N&V, hypotension or tachycardia
- 30min prior to IV oxytocin
- if ripening has not been sufficient within 24hrs
Why can balloon catheters be the preferable treatment for cervical ripening?
Reduced rates of uterine hyperstimulation and tachysystole, reduced rates of instrumental birth due to fetal distress and fewer neonatal intensive care admissions.
How much water should be inserted into the Foley catheter?
30ml
When should the Foley catheter be removed?
12-24hrs post insertion
- SROM
- onset of labour
- hyperstimulation or fetal distress
What is the brand name of oxytocin used for IOL?
Syntocinon.
What are the precautions for Syntocinon use?
- Bishop score <6
- Previous C/S
- within 6hrs of Prostin
- Within 30mins of Cervidil removal
- Multiparous women, particularly when epidural or other analgesia is used
How is the fetus to be monitored if Syntocinon is being used for augmented labour?
Continuous CTG.
What is the doses for standard Syntocinon during labour?
Begin with 12ml/hr up to 192ml/hr. Going up by 12ml/hr every 30min.
Starts 2miliunits/min going up by 2 every 30mins.
What needs to be aimed for in regards to contractions during Syntocinon use?
4:10 strong contractions with 60 seconds of resting tone.
What method of IOL is mostly used in the case of fetal death or termination?
Misoprostol
What should be done prior to an IOL?
Vital signs, check vaginal loss, abdominal palpation, CTG, uterine activity and a VE for a Bishop score.
How often should contractions be palpated during Syntocinon induction?
Every 30mins for 10mins.
