Induction of Labour and Intrapartum Care Flashcards
What is induction of labour?
Planned initiation of labour prior to spontaneous onset
How common is induction of labour?
Occurs in up to 25%
Why is induction of labour performed?
Presumed risk to mother/foetus of continuing pregnancy > risk of induction of labour = should only be performed if there is reasonable chance of success
What are the maternal indications for induction of labour?
Pre-eclampsia, poor obstetric history, medical disorders
What are the foetal indications for induction of labour?
Suspected IUGR, rhesus iso-immunisation, PROM, antepartum haemorrhage
What are some other indications for induction of labour?
Post date pregnancy, diabetes, obstetric cholestasis
What criteria are assessed in the Bishops score?
Consistency, position, dilatation, length, station
What would give a Bishops score of 0?
Firm consistency, posterior position, 0-1cm dilatation, length of 2-4cm, station of -3
What would give a Bishops score of 1?
Average consistency, mid position, 1-2cm dilatation, length of 1-2cm, station of -2
What would give a Bishops score of 2?
Soft consistency, anterior position, 2-4cm dilatation, length of 0.5-1cm, station of -1 or 0
What would give a Bishops score of 3?
Dilatation >4cm, length <0.5cm, station below the ischial spines
What are the methods of induction of labour?
Prostaglandins, mechanical, amniotomy, IV syntocinon
How are prostaglandins used to induce labour?
PGE2 Dinoprostone = prostin gel or propess pessary
What are the mechanical methods of induction of labour?
Membrane sweep, Foley balloon dilation
What observations are taken during the intrapartum period?
Hourly pulse, 4 hourly temperature and BP, vaginal examination 4 hourly, 30-60 mins contractions, frequency of urine passage
What pain relief can be given during the intrapartum period?
Non-opioids, entonox, opioid, epidural, remifentanyl
When should foetal monitoring be done during the intrapartum period?
For 1 min after a contraction
Every 15 mins in 1st stage of labour
Every 5 mins in 2nd stage
Continuous CTG monitoring
How is delay during labour managed?
Amniotomy or C-section
Syntocinon contractions every 4-5mins, increments every 30mins
What is the active management of the second stage of labour?
Routine use of uterotonic drugs
Deferred clamping and cutting of cord
What is active management of the second stage of labour associated with?
Nausea and vomiting, haemorrhage of >1L and need of blood transfusion
What is the physiological management of the second stage of labour?
No use of uterotonic drugs
No clamping of cord until pulsation has stopped
Delivery of placenta by maternal effort
What would be classed as delay in the third stage of labour?
Not completed within 30mins of birth with active management or 60mins with physiological management
How is delay in the third stage of labour managed?
Manage with MROP under anaesthetic
What is the treatment of post partum haemorrhage?
Empty bladder, uterine massage, uterotonic drugs, IV fluids, controlled cord traction if placenta not yet delivered
