Post date and IOL Flashcards
What are the complications of post-date?
Post-maturity syndrome, hypoxia, placenta insufficiency, increased morbidity and mortality
What are the causes of post-date?
- wrong date\irregular period
- unkown (breastfeeding-missed US)
- placnetal sulfatase def (starts the labor especially in anencephaly)
- increase maternal age & parity
How to diagnose post-date
- confirm gestational age (LMP or early first US)
How to manage post date in antepartum?
Offer Induction of labor at 41 weeks In medically free
If medically illness, we don’t let them go over 40, HTN and diabetic on insulin “39-38”
What if she declined induction of labor
Assess the kick chart, BPP, AFI and if she’s okay leave her
In intrapartum post-date, how do we manage?
Continues monitoring, and a neonatologist because of high risk of complication
What is the definition of induction of labor
Artifical stimulation of contractions “to dilate her cervix”
What is difference between induction of labor and augmentation of labor
First the cervix is not open, second the cervix is closed but labor uterine contractions is not sufficenct (labor started spontanously)
What are the indications of IOL?
- maternal: preclampsia, DM, HD, prolonged >42, renal disease
- fetal: RH, PROM, IUGR, choroiaminitis, fetal abnormality (syndromic)
Contraindications of induction?
Any contraindication of vaginal delivery
Ie:
- placenta previa
- Cephalopelvic disproportion (1 day delays with effective contractions)
- transverse lie
- prev. Classical CS (vertical) in uterus
- inverted T uterine incision
- myomectomy (fibroids removal)
- 2 ro more lower segment CS
- grand multiparity
- active genital herpes
- allergic reactions to inducing agents
Why is classical Cs causes uterine rupture
Because the fibers is horizontal
“Lower sigment is usually used, but only appears in term babies”
What are the risk of inductions
- failed induction
- iatrogenic prematurity
- difficult labor
- intrauterine infection
- cord prolapse
- uterine hyperstimulation
- operative delivery
- uterine atony and PPH
What are the prequisities of IOL?
- review Hx & exam (exclude contraction)
- confirm GA
- US
- informed consent
- bishop score
- pelvic adquacy
What are parts of bishop score
- cervix: position, consistency, effacement, dilation
- fetal head: station (ischial relation)
What are the methods of induction of labor
Mechanical and chemical
