Induction of Labour Flashcards
What is the difference between induction and augmentation?
Induction - artificial initiation of labour
Augmentation - progress of labour enhanced using synto
What are some foetal indications for IOL?
- IUGR/LGA
- Multiple pregnancy
- 3 x RFM
- IUD
What are some maternal indications for IOL?
- OC
- PET
- Postdates
- Diabetes
- PROM
- Maternal request
What is the difference between prolonged pregnancy and post-maturity?
Prolonged = >40 weeks according to EDD Post-maturity = pathologically prolonged pregnancy (>42/40)
When should women be induced for postdates and what are the advantages of this?
- Between 40+10 and 40+14
- Reduced risk of perinatal death, CS and infant morbidities such as meconium aspiration syndrome
What are the risks associated with induction/augmentation?
- Hyperstimulation
- Failed induction
- More painful/ less efficient labour
- Increased risk of instrumental delivery
- Fluid overload
What are the medications available for IOL?
- Propess (pessary) - 10mg
- Prostin (tablet) - 3mg
- Dilapan-S
How does Dilapan-S work?
Placed in cervix and expands by osmosis
When should a propess/prostin be given?
Bishop Score:
>6 = prostin
<6 = propess
Describe the procedure for IOL
- 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
How many prostins can be given in total?
4 (2 per 24 hour period)
What is different about IOL for PROM?
Only 1 prostin can be given
When can augmentation be commenced?
- Prostin should be given >6 hours before synto
- Propess should be given >30 mins before synto
When do sweeps occur?
- Primip = 40/40 and 41/40
- Multip = 41/40
What are the risks associated with sweeps?
- Infection
- ARM
When can an ARM be performed?
Bishop score >7
What is the concentration of syntocinon used?
5iu in 100ml of normal saline
How often can the rate of oxytocin be increased?
Every 30 mins
What are some common side effects of prostin?
- Hyperstimulation
- Uterine rupture
- Gastric disturbances
- Headaches
- Vaginal irritation
What are some common side effects of syntocinon?
- Hyperstimulation
- Uterine rupture
- Gastric disturbances
- Headaches
- Anti-diuretic
What are some common side effects of Mifepristone?
- D+V
- Infection
- Haemorrhage
What are some common side effects of Misoprostol?
- D+V
- Constipation
- Dizziness
List some ways of ‘bringing on labour’
- Curry
- Sex
- Raspberry leaf tea
- Dates and pineapple
- Nipple stimulation
- Castor oil
- Acupuncture
How does curry stimulate labour?
Bowel/uterine irritant
How does sex stimulate labour?
Orgasm releases oxytocin and friction on cervix releases prostaglandins
How does castor oil stimulate labour?
Bowel irritant
What is a major contraindication of commencing oxytocin?
Intact waters
What are the time intervals between prostins?
(Dilapan for 12 hours)
- 1st-2nd = 6 hours
- 3rd = 24 hours from 1st
- 3rd-4th = 6 hours
How should the baby be monitored during induction?
- 30 mins before each prostin
- 1 hour after each prostin
- 4 hourly in the 24 hour break
How often should an oxytocin infusion be replaced?
Every 12 hours
What rate should oxytocin be started at?
1st stage = 1.2ml/hr
2nd stage = 4.8ml/hr
How long after an ARM should oxytocin be commenced?
2 hours (or 4 for primips if they are contracting)
What is the maximum number of Dilapan that can be given?
5
