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YEAR 3 REVISION > Induction of Labour > Flashcards

Induction of Labour Flashcards

1
Q

What is the difference between induction and augmentation?

A

Induction - artificial initiation of labour

Augmentation - progress of labour enhanced using synto

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2
Q

What are some foetal indications for IOL?

A
  • IUGR/LGA
  • Multiple pregnancy
  • 3 x RFM
  • IUD
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3
Q

What are some maternal indications for IOL?

A
  • OC
  • PET
  • Postdates
  • Diabetes
  • PROM
  • Maternal request
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4
Q

What is the difference between prolonged pregnancy and post-maturity?

A 
Prolonged = >40 weeks according to EDD
Post-maturity = pathologically prolonged pregnancy (>42/40)
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5
Q

When should women be induced for postdates and what are the advantages of this?

A
  • Between 40+10 and 40+14

- Reduced risk of perinatal death, CS and infant morbidities such as meconium aspiration syndrome

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6
Q

What are the risks associated with induction/augmentation?

A
  • Hyperstimulation
  • Failed induction
  • More painful/ less efficient labour
  • Increased risk of instrumental delivery
  • Fluid overload
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7
Q

What are the medications available for IOL?

A
  • Propess (pessary) - 10mg
  • Prostin (tablet) - 3mg
  • Dilapan-S
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8
Q

How does Dilapan-S work?

A

Placed in cervix and expands by osmosis

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9
Q

When should a propess/prostin be given?

A

Bishop Score:
>6 = prostin
<6 = propess

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10
Q

Describe the procedure for IOL

A
  • Depending on bishop score, give propess and leave in situ for 24 hours
  • Remove propess and reassess bishop score
  • If >6, give prostin
  • Reassess after 6 hours, give another prostin if needed
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11
Q

How many prostins can be given in total?

A

4 (2 per 24 hour period)

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12
Q

What is different about IOL for PROM?

A

Only 1 prostin can be given

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13
Q

When can augmentation be commenced?

A
  • Prostin should be given >6 hours before synto

- Propess should be given >30 mins before synto

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14
Q

When do sweeps occur?

A
  • Primip = 40/40 and 41/40

- Multip = 41/40

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15
Q

What are the risks associated with sweeps?

A
  • Infection

- ARM

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16
Q

When can an ARM be performed?

A

Bishop score >7

17
Q

What is the concentration of syntocinon used?

A

5iu in 100ml of normal saline

18
Q

How often can the rate of oxytocin be increased?

A

Every 30 mins

19
Q

What are some common side effects of prostin?

A
  • Hyperstimulation
  • Uterine rupture
  • Gastric disturbances
  • Headaches
  • Vaginal irritation
20
Q

What are some common side effects of syntocinon?

A
  • Hyperstimulation
  • Uterine rupture
  • Gastric disturbances
  • Headaches
  • Anti-diuretic
21
Q

What are some common side effects of Mifepristone?

A
  • D+V
  • Infection
  • Haemorrhage
22
Q

What are some common side effects of Misoprostol?

A
  • D+V
  • Constipation
  • Dizziness
23
Q

List some ways of ‘bringing on labour’

A
  • Curry
  • Sex
  • Raspberry leaf tea
  • Dates and pineapple
  • Nipple stimulation
  • Castor oil
  • Acupuncture
24
Q

How does curry stimulate labour?

A

Bowel/uterine irritant

25
Q

How does sex stimulate labour?

A

Orgasm releases oxytocin and friction on cervix releases prostaglandins

26
Q

How does castor oil stimulate labour?

A

Bowel irritant

27
Q

What is a major contraindication of commencing oxytocin?

A

Intact waters

28
Q

What are the time intervals between prostins?

A

(Dilapan for 12 hours)

  • 1st-2nd = 6 hours
  • 3rd = 24 hours from 1st
  • 3rd-4th = 6 hours
29
Q

How should the baby be monitored during induction?

A
  • 30 mins before each prostin
  • 1 hour after each prostin
  • 4 hourly in the 24 hour break
30
Q

How often should an oxytocin infusion be replaced?

A

Every 12 hours

31
Q

What rate should oxytocin be started at?

A

1st stage = 1.2ml/hr

2nd stage = 4.8ml/hr

32
Q

How long after an ARM should oxytocin be commenced?

A

2 hours (or 4 for primips if they are contracting)

33
Q

What is the maximum number of Dilapan that can be given?

A

5

YEAR 3 REVISION (49 decks)

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