induction of labour Flashcards
urgent indiciaations for IOL
severe pre-eclampsia/HELLP syndrome
chorioamnionitis
confirmed foetal compromise of IUGR
- abnormal CTG
- abnormal dopplers
prolonged ruptured membranes
priority indications for IOL
oligohydramnios
diabetes
gestational hypertension
cholestasis
fetal demise
rhesus isoimunicaation
non urgent indications for IOL
gestation over 41 weeks + 3 (offered routinely at 41 weeks)
confirmed macrosomia
uncomplicated twins
advanced maternal age (increases risk of stillbirth)
why is IOL offered for post dates
increased risk of stillbirth/perinatal deth
macrosomia
birth trauma
intrapartum asphyxia
PPH
c/s rate
perinatal mental health issues
stages of IOL
cervical ripening
artificial rupture of membranes
stimulate contractions
cervical ripening
natural - stretch and sweep
hormonal - prostaglandins, prostin gel, misopristol
mechanical - transcervical catheter, osmotic dilator
modified bishop score
tool to assess readiness of patient’s cervix to dilate, by DVE
bishop score >/=8 means
favourable cervix associated with an increased chance of being responsive to IOL interventions
methods of cervical ripening
mechanical: stretch and sweep or transcervical balloon catheter
pharmacological: PGE2 pessary (cervidil) or PGE2 gel
prostaglandins
pharmacological methods when bishop score <8
PG E2 gel: 1-2 mg doses
cervidil: 10mg controlled release pessary
transervical catheter
non-pharmacological method
saline-filled balloon with 80ml sterile water pressure to the lower uterus and cervix resulting in local production of prostaglandins and cervical ripening
can be removed quickly if required, less likely to cause uterine hyperstimulation
PGE2 pessary/cervidil
tape containing PGE2 placed around the posterior fornix
PGE2 gel
applied to the posterior fornix
what is excessive uterine activity
uterine tachysystole: >5:10 contractions without FHR abnormalities
uterine hypertonus: contractions >2 minute duration or occurring within 60 seconds of each other without FHR abnormalities
uterine hyperstimulation: either one of these but WITH FHR abnormalities
artificial rupture of membranes
amnicot or
amnihook
why do you need a formal rupture of membranes
hindwaters may have broken (waters behind the baby)
but sometimes there is. plug of forewaters that need to be broken as well
complications of oxytocin
delaayed breast milk production
uterine hyperstimulation
hyponatraemia
hypotension
stimulation of uterine contractions
IV oxytocin infusion (syntocinon)
to establish uterine activity sufficient to induce cervical change and fetal descent
contraction frequency of 3-4:10
with 60s duration, 60s break in between
dosing of syntocinon infusion
starting dose 12ml/hr
increase infusion rate every 30 minutes
when to start oxytocinon infusion
leave 6 hours after PGE2 gel administration
leave 30 minutes of PGE2 pessary removal
use with caution in grand multiparity or VBAC
complications of IOL
hyperstimulation of the uterus
uterine rupture (if pt had a previous c-section)
fetal immaturity
umbilical cord prolapse following ARM
contraindications for IOL
placenta praevia, vasa praevia, malpresentation
known cephalopod-pelvic disproportion
acute foetal compromise
cord presentation or prolapse
maternal - active herpes, HIV positive, maternal refusal
things to consider before starting IOL
review patient history and pregnancy
confirm gestational age
any contraindications for IOL
abdominal palpation
CTG and monitoring
VE
bishop score
what if IOL is unsuccessful
inform the obstetric consultant
rest period prior to reassessment
?C/S
