Induction of Labour, Intrapartum care, and Delivery Flashcards
indications for induction of labour
Post term pregnancy
Prelabour rupture of membranes over 36 weeks
Hypertensive disorders
Fetal demise
Diabetes
Fetal growth restriction
Chorioamnionitis (stable)
APH/abruption (stable)
Oligohydramnios
Intrahepatic cholestasis of pregnancy
Alloimmunization
Twins
Other maternal disease states
Other fetal abnormalities.
T/F it’s actually better to have a planned induction of labour at term
truee. ARRIVE TRIAL FINDINGS: Maternal consequences of planned induction of labour 39+0-39+4 versus expectant management. Findings: reduced risk of C Section, reduced risk of hypertensive disorders of pregnancy and neonatal respiratory support.
Contraindications for Induction of Labour
Prior classical C Section
Prior uterine rupture
Prior transmural uterine incision entering uterine cavity
Active genital herpes infection
Placenta previa or vasa previa
Umbilical cord prolapse or funic presentation
Transverse fetal lie
Invasive cervical cancer
Abnormal fetal heart rate tracing or nonreassuring fetal status.
What is Bishop’s score and what are its components. (PEDCSP)
cervical assessment tool prior to induction.
P- position and parameter
D- dilation
E- effacement
S- station
- C- sonsistency of cevix
if bishops score is less than ___, we should use cervical ripening. what are the methods to cervical ripening?
if less than 6, consider cervical ripening:
- mechanical and sweeping
- prostaglandins: cervidil or misoprostal
Tf you can use misoprostal as a method of cervical ripening
true. but not for tolac
most common method of induction
oxytocin.
If you combine oxytocin with ___, you can cause overstimulation. Why is this bad?
oxytocin combined with prostaglandins because can cause overstimulation of the uterus.
- baby will get decels due to too many contractions.
4 P’s of maternal factors of labour
Power: uterine contractility and maternal expulsive effort
Psyche: confidence and encouragement, pain control
Passage: maternal bony pelvis or soft tissues of the birth canal
Passenger: presentation position or development of the fetus
Stages of Labour
First stage: time from onset of labour to complete cervical dilation.
Latent 0-6cm: gradual cervical change
Active 6-10cm: rapid cervical change
Second Stage: time from full dilation and fetal expulsion
Passive: from complete dilation to maternal pushing efforts
Active: from active maternal pushing to expulsion of the fetus
Third Stage: time from fetal expulsion to placental expulsion.
when you should you do a cervical examination?
On admission, Q2-4 hrs in the first stage, prior to administering analgesia/anesthesia, when the patient feels the urge to push, Q1-2h in the second stage
If fetal heart rate abnormalities occur (to evaluate for complications such as cord prolapse, uterine rupture or fetal descent.
outline the cardinal movements of labour
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
Every fine day infants enter eager and excited
most common fetal position
left occiput anterior position, back of fetus head is pointing to the anterior pelvis
When should you consider group B strep prophylaxis
Risk factor based approach if screening isn’t available:
Intrapartum fever >38.0
GBS status unknown
Rupture of membranes >18 hours
Previous delivery of infant with GBS infection
GBS infection UTI
Delivery at <37 weeks.
Standard is penicillin G (if allergic, clindamycin or ceftriaxone)
definition of protracted first stage of laobur
dilation less than 1-2 cm in an hour in women in active phase of labour >6cm
definition of arrest of labour
no change in cervix for over 4 hours despite adquate contractions and ROM, or no change in cervix for over 6 hours despite inadequate contractions and ROM
definition for protracted second stage of labour
not clearly defined, but allow up to 4 hours pushing for nulliparous and 3 hours for multiparous, when maternal and fetal conditions permeit
management of failure to progress in the first stage (which P is biggest factor)?
consider the cause: think of the 4 Ps
Power is more prominent cause in this sage
Role of intrauterine pressure catheter to
contractions
Amniotomy if membranes intact
Oxytocin augmentation.
management of failure to progress in second stage, which P is the biggest factor here?
unlike in the first stage failure, power is less likely the issue. There is an increased risk of PASSAGE or PASSANGER PROBLEM: obstructive cause such as malposition of pelvic issue
Management:
Manual rotation in some cases
Maternal support, coaching, position changes
Oxytocin can be considered
Assisted vaginal delivery
C-Section
active management of third stage of labour (delivery of placenta)
- Administration of prophylactic uterotonic agent (oxytocin) with delivery of anterior shoulder
- Controlled traction on the cord
- +/- uterine massage
Has been shown to reduce hemorrhage, need for additional therapeutic uterotonic and transfusions
Placenta should not be forced! Can cause uterine Inversion
signs that the placenta is going to get delivered soon
Lengthening of the cord
Gush of blood from the vaginaa
Change in shape of the uterus (discoid → globular)
Elevation of the fundal height
Contraction of the fundus
risk factors for retained placenta
Previous retained placenta
Preterm gestation
Uterine anomalies
Placenta accreta spectrum
Preeclampsia
Still birth
Small for gestational age fetus
Velamentous cord insertion
requirements of induction of labour
indication (maternal or fetal)
cervical exam (bishop score)
Normal NST
maternal stability (or response to meds/tx)
patient consent
