IOL counselling Flashcards
What are (3 main) indications for IOL
PROM
Pre-eclampsia
IUGR
Prolonged pregnancy
Mother’s choice
Macrosomia
Stillbirth/death
Infection
When to IOL
> = 41W (nulliparous; 40 if multi)
mechanical vs pharma start
low bishop score –> pharmacological
high bishop score –> mechanical
outcome if IOL doesn’t happen when it’s supposed to
IU death // stillbirth // c-sec // neonatal admission
IOL steps
Membrane sweep (separate membrane from uterus wall)
Vaginal Pessary prostaglandins + oral misoprostol => soften cervix + stimulate contractions
re-examine in 6hrs –> 2nd dose if needed
Amniotomy –> water breaks –> natural PGE released
Oxytocin => Stimulate contractions
Where to IOL
happens on ward
continuous CTG required, connected to oxytocin drip
doesn’t affect intervention rate (not after 39 weeks)
IOL CIs
Placenta lieing across cervix
Breech Position
Acute foetal compromise
Placenta praevia
IOL main complication & management steps
Uterine hyperstimulation (you get less and less time between each contraction)
– oxytocin rate –> terbutaline
other complications include: uterine rupture, IU infection if prolonged membrane rupture, foetal distress
if IOL does not work
C-section
check if woman has (2)
asthma hptn
Pain relief during IoL
enotnox
diamorphine
structure of IOL counselling
what is IOL
reassure
reasons for it
risks and benefits
alternative options
stress consent & take time to discuss with loved ones & decide
comparing induced to normal labour
few places available (hospital, no pool)
longer stay
maybe more painful - reassure with pain relief
if they choose NOT to have induced labour
gentle reminder of adverse effects
foetal monitoring followed by twice-weekly monitoring
only tells us info in moment, no one knows what happens in between
offer them to discuss decision again at subsequent reviews
offer to phone midwife anytime they change their mind or have concerns about baby
