NICE GUIDELINES - IOL Flashcards
What are the risks associated with a pregnancy continuing over 41:0?
- increased likelihood of Caesarean section
- increased likelihood of baby being admitted to a NICU
- increased likelihood of stillbirth and neonatal death
What are the steps to take if a woman declines IOL?
- discuss additional fetal monitoring
- advise that additional monitoring only gives a snapshot in time
- adverse events cannot be predicted reliably using extra monitoring
- fetal monitoring could include twice weekly CTG and amniotic fluid assessment
- rediscuss and return precautions must be discussed
If a woman has PPROM when should IOL be offered?
Can offer IOL from 34/40 onward (not done in Auckland)
- immediate IOL vs C/S
- expectant management until 37/40
How to manage a woman with prelabour rupture of membranes at term?
- offer immediate IOL vs expectant management at 24hrs
- immediate IOL recommended for GBS +ve women with PROM
IOL in context of previous C/S
- management?
- IOL can lead to increased risk of Em CS
- IOL can lead to increased risk of uterine rupture
- mechanical method of IOL preferred over Prostin
- dinoprstone and misoprostol contraindicated with women with previous scar
If birth needs to be expedited in context of woman with previous CS you can offer:
- IOL
- repeat CS
record in notes maternal wishes and discussion
respect a women’s decision
maternal request IOL management
- Consider this option following comprehensive discussion about risks and benefits
In which scenario could you consider offering an IOL for a breech
birth needs to be expedited, and
external cephalic version is unsuccessful, declined or contraindicated, and
the woman chooses not to have a planned caesarean birth
In which scenario could you consider offering an IOL for a breech
birth needs to be expedited, and
external cephalic version is unsuccessful, declined or contraindicated, and
the woman chooses not to have a planned caesarean birth
what are the 5 steps you need to carry out before IOL commences?
- abdominally palpate - ?high presenting part >cephalic
- bedside USS for presentation if required
- assess and record bishop score
- confirm normal CTG
- confirm absence of significant uterine contractions
what are the 5 steps you need to carry out before IOL commences?
- abdominally palpate - ?high presenting part >cephalic
- bedside USS for presentation if required
- assess and record bishop score
- confirm normal CTG
- confirm absence of significant uterine contractions
How would you counsel a woman with a macrosomic baby regarding IOL?
There is uncertainty about the benefits and the risks of IOL cf to expectant management however:
- Shoulder dystocia incidence is reduced in IOL cf expectant management
- The risk of 3&4 degree tears increase with IOL vs expectant management
- There is evidence that the risk of perinatal death, brachial plexus injury and the need for an Em CS is the same for both
How would you counsel a woman regarding mode of delivery following confirmation of intrauterine fetal demise?
- If membranes are intact
- No evidence of infection or bleeding
- Can offer IOL, expectant management or CS
RESPECT the womens decision
If a woman has a diagnosed IUD and chooses to opt for an IOL AND has a non scarred uterus how would you proceed?
- Offer mifepristone 200mg
- Prostaglandin or balloon
If a woman has a diagnosed IUD and has had a previous C/S how would you counsel her?
- IOL can increase risk of uterine scar rupture
- IOL method should be guided by risk – mechanical advised over prostaglandins
