Induction of Labour Flashcards
(13 cards)
What is the cumulative proportion of spontaneous labours before a) 37/40, b) 40/40, c) 41/40?
a) 8%
b) 83%
c) 99%
What risks are increased beyond 41/40?
- Caesarean
- NICU admission
- Stillbirth & NND
What are the rates of stillbirth for a) white, b) black, c) Asian, d) least deprived, e) most deprived babies?
a) 34:10,000
b) 74:10,000 (double)
c) 53:10,000 (1.5x)
d) 26:10,000
e) 47:10,000 (double)
What should be offered to women who decline IOL at 42/40?
- Twice weekly CTG
- Twice weekly US for liquor
- Rediscussion of options
What IOL decisions are recommended in PPROM?
a) <34/40: no IOL unless infection or fetal compromise
b) 34-37/40: IOL if GBS or concerns
c) >37/40: IOL
What IOL decisions are recommended in PROM >37/40?
a) offer expectant for 24 hours vs immediate IOL
b) immediate IOL or CS if GBS
What are the considerations for IOL with VBAC?
- Increased risk of EmCS & uterine rupture
- Prostaglandins contraindicated
- Option of ElCS
What are the considerations for IOL with breech?
- Generally not recommended
- Consider if need expedited birth, can’t/won’t ECV & CS declined
What are the considerations for IOL with FGR?
Don’t do it confirmed fetal compromise
In suspected fetal macrosomia without diabetes, how does IOL impact on risks?
a) IOL reduces shoulder dystocia
b) IOL increases OASI
c) same: perinatal death, brachial plexus injuries, EmCS
What methods are recommended for IOL?
- Membrane sweep
- Prostaglandins if Bishop <6
- Mechanical if Bishop <6
- Amniotomy if Bishop >6, then either immediate or delayed oxy
How should fetal heart rate be monitored with IOL?
- CTG before commencing
- CTG when contractions start; if normal, IA until labour established
- Continuous once labour established
What are the definitions of a) hyperstiumulation, b) hypersystole/ hypertonicity?
a) >5:10 for > 20 mins
b) contraction lasting >2 mins
