Induction and instrumental delivery Flashcards Preview

Stage 3: EJR - Obstetrics > Induction and instrumental delivery > Flashcards

Flashcards in Induction and instrumental delivery Deck (22):
1

What gestational age is the legal definition of foetal viability in the UK

over 24 weeks

2

Foetal reasons for induction

-IUGR
-Rhesus incompatibility
-recurrent reduced foetal movements
-post maturity
-Intra-uterine death
-previous stillbirth

3

Maternal reasons for induction

-maternal age
-hypertensive disorders
-diabetes
-obstetric cholestasis
-recurrent antepartum haemorrhage
-symphysis pubis dysfunction
-on medication for VTE
-maternal request

4

Contraindications to induction

-major placenta previa
-transverse/oblique foetal lie
-previous vertical C section
-active genital herpes
-HIV (depends on viral load)

5

List 4 different methods of induction

-Membrane sweep
-Prostaglandin E2
-Amniotomy
-IV oxytocin

6

After what gestational age is membrane sweep performed

After 40w (can only do if cervix is dilated)

7

How does a membrane sweep work to induce pregnancy

Stripping membranes causes

o increase in release of prostaglandins & phospholipase activity

o mechanical dilation of cervix which release prostaglandins

8

Components of bishop score

-dilation
-cervix length
-cervix hardness
-cervix position (more anterior is good)
-station of baby's head

9

What does a higher bishop score indicate

Good - means cervix is more ripe

10

Why must amniotomy be performed before starting IV infusion of oxytocin

Otherwise, risk of amniotic fluid going into mother's bloodsteam

11

Risks of induction before labour

-increased analgesia use
-failure leading to C section
-uterine hyperstimulation

12

Risks of induction during labour

-foetal compromise
-cord prolapse
-uterine rupture
-intrauterine infection
-precipitate dysfunctional labour
-increased risk of operative vaginal delivery

13

Risks of induction after labour

Post partum haemorrhage

14

When are non rotational forceps used

In babies who are already facing occipital-anterior position

15

2 different types of instrumental delivery

1. ventouse (preferred)
2. forceps (rotational and non-rotational)

16

Indications for instrumental delivery

• Prolonged second stage (maternal exhaustion)
• Foetal compromise
• Prophylaxis: cardiac/ retinal detachment/ hypertension
• Breech

17

Does ventouse or forceps have a greater failure rate

Ventouse (cup can fail if placed incorrectly)

18

Maternal complications of ventouse and forceps

• Vaginal lacerations
• Postpartum haemorrhage
• 3rd degree tears

19

Foetal complications of ventouse delivery

• Chignon (temporary swelling on head)
• Scalp lacerations
• Cephalhaematoma (bleeding between skull & periosteum)
• Neonatal jaundice

20

Foetal complications of forceps delivery

• Facial bruising
• Facial nerve damage
• Skull & neck fractures

21

Type of anaesthesia given for low cavity instrumental delivery (head well below ischial spines)

Pudendal block
Local anaesthesia

22

Type of anaesthesia given for low cavity instrumental delivery (head at ischial spines)

Epidural
Spinal anaesthsia