Induction of Labour Flashcards
1
Q
Indication of IOL
A
Maternal and fetal benefit Consider individual circumstances Potential circumstance Prolonged pregnancy PPROM/PROM Previous caesarean section Obstetric cholestasis Diabetes Hypertensive disorder Twin pregnancy Suspected fetal macrosomia Fetal growth restriction IUFD Maternal request Other maternal conditions Post dates
2
Q
Contraindication of IOL
A
Maternal - Prior classical or inverted T-Incision or uterine surgery eg myomectomy - Unstable maternal condition - actie maternal genital herpes - invasive cervical carcinoma - pelvic structure deformities Maternal fetal - Placenta previa or vasa previa - Cord presentation Fetal - fetal distress, malpresentation, preterm fetes without lung maturity
3
Q
Risk of induction of labour
A
Failure to achieve labor and or vaginal birth
uterine hyperstimulation and fetal compromise
maternal side effects to medications
Uterine atony and PPH
Uterine rupture
4
Q
Types of IOL
A
Membrane sweep ARM Transcervical catheter Prostaglandin Oxytocin
5
Q
IOL - Membrane sweep
A
Indications - 39-40 wks gestation Contraindications Low lying placenta Elective caesarean section is planned Advise may cause discomfort, bleeding and irregular contractions
6
Q
IOL - ARM
A
Indictions - Favourable cervix Cautions - Avoid with high head Requirement Monitor FHR immediately post procedure Document liquor colour/consistency Mobilise
7
Q
IOL Transcervical catheter
A
Indications - unfavourable cervix Contraindication - Low lying placenta Cautions - APH, ROM, Cervicitis Requirement Monitor FHR appropriate for circumstance R/V in 12hrs if need delivered
8
Q
IOL - Prostaglandin
A
Indications - unfavourable cervix Contraindications Hypersensitivity to prostaglandin Grandmultiparity - gel High Parity >3 - pessary Previous uterine surgery High uterine surgery High presenting part Malpresentation requirement CTG - 3omin minimum Recumbent left lateral for 30min post insertion Temp, BP, Pulse, monitor uterine activity and PV loss hourly for 4 hours VE reassess 6hrs after gel or 12hr for controlled released
9
Q
IOL - Oxytocin
A
Indications: Favourable cervix (if unfavourable then use PGE2) Cautions: Not within 6 hrs of gel Not within 30mins of removal of pessary Previous uterine surgery High parity >4 Requirement One to one midwife care ARM prior to oxytocin Continuous CTG assess uterine contractions for 10min every 30mins Obs as per normal labour guidelines and prior to rate raise. Maintain fluid balance Assess progress of labour
10
Q
Counseling a women on IOL
A
Maternal and fetal benefit and risk Indications Methods of IOL pain relief Possibility to failure time for decision-making Document above
11
Q
Pre induction assessment
A
R/V Hx confirm gestation Baseline observations - temp, pulse, BP Abdopalpation - presentation, engagement CTG Assess membrane status Vaginal examination
12
Q
Cervix favourable vs not
A
Favourable = Bishop score >6 Unfavourable = bishop score =6
