Birth Related Procedures Flashcards
What is external cephalic version?
A procedure to turn the baby by external manipulation of the maternal abdomen into a cephalic position from a breach or transverse lie
It has the highest chance of success for a transverse presentation
What is a contraindication for attempting a version?
Intrauterine growth restriction
Fetal or uterine anomalies
Abnormal FHR tracing
ROM, oligo, polyhydramnios
Certain maternal complications
Prior lower uterine scar
Define cervical ripening
Using prostaglandins or mechanical means to soften and efface the cervix. Often used to increase the likelihood of a successful labor induction.
What are contraindications for cervical ripening?
Non-reassuring FHR tracing
Prior uterine surgery/scar
Undiagnosed vaginal bleeding
Suspected CPD
What are the prostaglandins used for cervical ripening?
Misoprostol (cytotec)- administered in tablet form by mouth or inserted vaginally
Dinoprostone (cervidil)- administered via vaginal insert, it has the advantage that it can be removed a problems occur
Dinoprostone (prepidil)- administered in gel form inserted via catheter into the cervical os
What is labor induction?
The stimulation of contractions prior to the spontaneous onset of labor, for the purpose of delivery
What is labor argumentation?
Artificial stimulation of contractions when spontaneous contractions have failed to result in progressive cervical dilation, or the descent of the fetus
When might you do a labor induction or argumentation?
Maternal or fetal medical conditions:
Diabetes
Preeclampsia/eclampsia
IUGR
Post term pregnancy
Premature rupture of membranes
Fetal demise
What are contraindications for labor induction or argumentation
Prior cesarean via classical incision
Transverse lie
Complete placenta previa
Active genital herpes infection
Immature fetus
What are the methods for induction or augmentation?
Stripping the membranes
Oxytocin infusion
Alternative methods:
Castor oil
Acupressure/acupuncture
Herbs or homeopathic solutions
Nipple stimulation
sex
What is stripping the membranes?
A gloved fingers inserted into the cervical os and rotated 360° twice to separate the amniotic membranes, which is believed to release natural prostaglandins
What is oxytocin infusion?
Oxytocin is diluted in an isotonic solution, and carefully titrated via IV pump to achieve an adequate contraction pattern (3-5 contractions per 10 mins)
What is amniotomy
Artificial rupture of membranes (AROM)
Can be used to induce or augment labor
Allows placement of internal monitoring devices:
-fetal scalp electrode (FSE)
- Intrauterine pressure catheter (IUPC)
Define forceps assisted birth
Use of a pair of metal instruments (forceps) to facilitate delivery of the babies head during second stage of labor
When is the use of forceps indicated?
Sometimes indicated when mother or baby is at risk and immediate delivery would help:
-Maternal heart disease or exhaustion
-Prolapsed umbilical cord
-placenta abruption
