Induction of Labour Flashcards

1
Q

How many labours are induced?

A

10-20%

Success rate 60-80% at term

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2
Q

Indications for induction

A

Uteroplacental
Insufficiency (one of the most common), Prolonged Pregnancy, IUGR, Oligo or Anhydramnios,
Abnormal CTG, PROM, Severe Pre-Eclampsia or Eclampsia after maternal stabilisation, Intrauterine Death, Antepartum Haemorrhage at term,
Chorioamnionitis; Macrosomia is a controversial indication

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3
Q

Medical Indications for Induction

A

Severe HTN, Uncontrolled DM, Renal Disease or Malignancy

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4
Q

Predictors for successful induction

A

Gestational Age, Parity, Bishop’s Score

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5
Q

Mechanical Induction

A

Separation of Membranes from Cervix leads to Local release of Prostaglandins;
Artificial Separation (=Stretch and Sweep); 30% into Spontaneous labour <7 days, in majority
it improves Bishop score

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6
Q

Prostaglandins

A

Prostaglandins (PGE2 =Dinoprostone) – Intravaginal into Posterior Fornix as gel or tablet
o CTG should be performed 30 minutes before, and after insertion to confirm wellbeing and detect Hyperstimulation; Additional doses if still not favourable after 6hrs; Multiparous seldom need more than one dose
o Oxytocin should not be started for 6hrs to avoid Uterine Hyperstimulation

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7
Q

Oxytocin Infusion

A

Increases Cervical Prostaglandin levels and initiating Uterine Contractions with Myometrial receptor activation
o Best used when membranes have ruptured (either PROM or Amniotomy)
o Low dose (1-4 mIU/min); Doubled every 40 mins to achieve optimal contractions
o Continuous CTG monitoring; Sensitivity of Myometrium to Oxytocin increases during
labour, so rate needs to be revised

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8
Q

Amniotomy

A

Releases Local Prostaglandins causing Cervical Ripening and Myometrial Contractions; If not initiated or no cervical changes after 2hrs, Oxytocin infusion commenced

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