Induction and Augmentation of Labour Flashcards Preview

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Flashcards in Induction and Augmentation of Labour Deck (24):
1

What is induction of labour cf augmentation?

The process of causing labour to commence (and continue); augmentation is the process of stimulating a labour already commenced

2

What must be considered in deciding to induce labour?

The risks of continuing the pregnancy cf those of interrupting the pregnancy

3

What are the reasons to induce labour?

- Post maturity: EDD +10d
- HTN /PEt
- DM
- ROM / chorioamnionitis
- IUGR
- Foetal compromise
- Blood group isoimmunisation
- Abruption
- Twin pregnancy
- FDIU
- TOP
- Social

4

What are reasons not to IOL?

- Prematurity
- IUGR*
- Foetal compromise *
- Breech / transverse lie
- Praevia
- Previous LUSCS
- Cephalopelvic disproportion
----
* may be better delivered via LUSCS

5

What are the methods to induce labour?

1. Prostin E2
2. ARM
3. Syntocinon
May require 1, 2 or all to achieve IOL

6

What is the role of pristine?

Prostaglandin E2 used to ripen the cervix: soften and partially dilate to allow ARM

7

What are the risks of prostin?

May cause uterine hyper stimulation with:
- foetal distress
- precipitate labour
- uterine rupture

8

When should prostin be avoided?

- Previous uterine scar
- Ruptured membranes

9

What is required during prostin administration?

CTG monitoring before and after administration

10

What is ARM?

Small hook or forcep used to rupture the forewaters

11

What must be considered when performing ARM?

Bewared cord prolapse if presenting part not well applied

12

What is syntocinon?

Posterior pituitary polypeptide which stimulated uterine muscle contraction

13

Risks of syntocinon?

- Uterine hyper stimulation with foetal distress (need CTG)
Side effects:
- Nausea
- Vomiting
- Water intoxication
- Hyponatremia

14

What are the complications of IOL?

- Cord prolapse (poorly applied presenting part)
- Uterine hyperstimulation (rupture, precipitate delivery) with PE2 or syntocinon
- Foetal distress
- Process may fail

15

What is the role of instrumental delivery?

Facilitate or expedite vaginal delivery
- Foreceps
- Ventouse Vacuum

16

When should instrumental delivery be considered?

1. Delay in 2nd stage of labour:
- maternal exhaustion
- effective epidural
- malposition of presenting part
2. Foetal distress in second stage necessitating expedition of delivery

17

What is appropriate analgesia for an instrumental delivery?

- Epidural
- Spinal
- GA
- Pudendal block with perineal infiltration of local

18

What is required for an instrumental delivery?

- Experience with instrument
- Cervix fully dilated
- Foetal head engage
- Cephalic
- Analgesia
- Lithotomy
- Catheter (bladder empty)
- Resuscitation for baby
- May need episiotomy

19

What is the role of Neville Barnes forceps?

For anterior positions of foetal head

20

What are Keilland's forceps used for?

To rotate the posterior position head to an anterior position; then apply NB forceps for delivery from anterior position

21

What may the ventouse vacuum be used for?

Delivery from anterior position; or to rotate to anterior with subsequent delivery

22

What are the complications of forceps delivery?

Excessive force or incorrect application may cause:
- bruising
- facial nerve palsy
- damage to C spine
- intracerebral bleed

23

What are the complications of Ventouse?

- Temporary chignon
- Circular bruise
May cause:
- Subaponeurotic bleeding
- Intracerebral bleeding

24

What are the maternal complications of instrumental delivery?

Soft tissue tears and bruising to vagina and perineum