IOL Flashcards
What is IOL?
induction of labor
what are the prerequistes for IOL
C/S capability if neccessary
Maternal
- inducible or ripe cervix : short, thin, anterior soft
- can help cervix along with Cervedil or prostin
Foetal
- normal CTG
- cephalic presentation
- CTG available
What is success of an IOL determined by?
Bishop score
What are the components to the Bishop score?
Cervix effacement (as a %) cervix dilatation cervix softness (soft, medium, hard) Anterior or posterior cervix Fetal station (-3 --> +3)
each scored out of 3 for a total of 13??
What is a favourable and unfavourable cervix?
>6 = favourable 9 = most likely going to deliver vaginally
What are the indications for IOL?
- Post dates (>41 weeks)
Maternal factors:
- DM
- Gest HPTN
- other problem (renal etc)
Fetal
- suspected fetal demise
- IUGR
Materno-fetal
- isoimmunisation
- PROM
- chorio
- post term pregnancy
What are the risks of IOL?
- failure to achieve labour
- uterine hyperstimulation & fetal compromise
- maternal side effects to medications
- uterine atony and PPH
- uterine rupture
Contraindications to IOL?
Maternal
- previous classical or inverted T C/S or uterine surgery
- active genital herpes
- unstable maternal conditions
- cervical carcinoma
- pelvic structure deformity
Materno-Fetal
- placenta previa/ vasa previa
- cord presentation/prolapse
Fetal
- Fetal distress
- malpresentation
- premature w/o lung formed
What methods of cervical ripening/ induction are there?
Cervical ripening
- use of meds to soften and produce favourable cervix
Methods:
- stretch and sweep (PV exam to pull amniotic sac off cervix)
- PV prostaglandin gel : Prostin
- Cervedil: string/tape (may use if ROM)
- Foley catheter placement
IOL
Amniotomy: AROM w/ hook –>stimulates prostaglanding secretion
Oxytocin: run at set rate depending on patient
What are the risks of oxytocin use in IOL
hyperstimulation/tetanic contraction
uterine muscle fatigue –> atony
Anti diuresis effect
