University:
Stanford University
Course:
PEDS 282 | Pregnancy, Birth, and Infancy
Academic year:

2023
Views:

329

Pages:

1
Author:

Pierre BERNARD

Induction of Labour Indications Post dates (>10 days) bec increased risk of stillbirth Fetal growth restriction with risk of compromise (eg pre-eclampsia) Diabetic pregnancy with LGA Deterioration of fetus (haemolytic disease, TTTS, hydrops, cardiac problems) Deterioration of maternal health (PET, cardiac, renal, SLE, maternal malignancy requiring treatment etc) Assessment of cervix (Bishops score) Cervical dilatation Length of cervix Station of presenting part (in relation to ischial spines) Consistency Position If <6 then give vaginal prostaglandin to ripen cervix If > 6 then à ARM or syntocinon Prostaglandins (inc misoprostol) Promote cervical ripening & stimulate contractility. Can à nausea, vomiting & diarrhoea Reassess cervix in 6 hrs, if no change readminister & chech again in 6 hrs Once Bishops > 6 à ARM DO NOT give prostaglandin if there is regular uterine activity Artificial Rupture of Membranes (ARM or amniotomy) Used to induce or speed up labour à prostaglandin release, uterine decompression and assessment of liquor colour NB – if head not properly engaged can --> cord prolapse --> fetal asphyxia (cord spasm due to air) or arm prolapse (requires C-sect). Multips have greater chance of malpresentation as decreased uterine tone. GBS is contraindication to ARM due to meningitis risk (give 4 hrs i.v. Abx). If not possible give monitor & give baby Abx Syntocinon Used for induction after ARM or augmentation of slow labour Should only be used after membrane rupture Continuous CTG is mandatory (titrate dose to contractions. Aim < 8 in 15 mins Membrane Sweep VE & place finger through internal os to separate membranes from wall à natural prostaglandin release Antiprogesterones Mifepristone – softens cervix & increases uterine activity (not currently liceneced)