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Induction of Labour...as a treatment for 'overdue' pregnancy   Sarah Stewart 2011 http://www.flickr.com/photos/31929257@N0...
Definitions   <ul><li>Term (as in a ‘normal’ and healthy gestation period): is from 37 weeks to 42 weeks. </li></ul><ul><l...
Most women birth between 41 and 42 weeks gestation http://www.flickr.com/photos/48819968@N00/84515824
In Australia... <ul><li>26.2% women have their labour induced </li></ul><ul><li>50% women are first time mums </li></ul><u...
Clinical guidelines recommend that women should be offered induction of labour between 41 and 42 weeks gestation NICE, 200...
Expectant management <ul><li>Thought to be increased risk of fetal death if pregnancy lasts past 42 weeks but no clear evi...
Clinical guidelines recommend surveillance after 42 weeks eg ultrasound scan and CTG, but no evidence to support efficacy ...
Membrane sweep <ul><li>Sweeping the membranes is effective in bringing on labour before 41 weeks </li></ul><ul><li>Causes ...
Homoeopathy   No evidence to support its use http://www.flickr.com/photos/22198928@N00/841883683
Not enough evidence to support acupuncture http://www.flickr.com/photos/51035747113@N01/10920514
Risks of induction of labour <ul><li>Start of the 'cascade of intervention' </li></ul><ul><li>More likely to need epidural...
Contraindications  <ul><li>Maternal refusal </li></ul><ul><li>Malpresentation  </li></ul><ul><li>Previous major surgery – ...
Induction of labour should not be started if Bishop Score is less than 6.  A score of 8/9 indicates a “favourable” cervix
http://medchrome.com/major/gynaeobstr/bishop-score-and-modified-bishop-score/
Prostin <ul><li>Vaginal prostagladin gel is preferred method of IOL </li></ul><ul><li>Regime varies from hospital to hospi...
Care of woman <ul><li>Informed consent </li></ul><ul><li>Assessment of woman including health, history, EDD and abdominal ...
ARM <ul><li>Disrupts normal progression of labour and often leads to other interventions </li></ul><ul><li>Should not be u...
Contraindications  <ul><li>High presenting head </li></ul><ul><li>Polyhydramnios </li></ul><ul><li>Preterm labour </li></u...
Care of the woman <ul><li>Informed consent </li></ul><ul><li>Exclude contraindications </li></ul><ul><li>Maternal and feta...
Oxytocin   <ul><li>Intravenous syntoconon is not as effective as vaginal prostagladin </li></ul><ul><li>Used with ARM is a...
<ul><li>Once ARM is performed, there's no going back </li></ul><ul><li>IVI is very restrictive </li></ul><ul><li>Must be c...
Key points <ul><li>Midwife's role is to be advocate – be mindful of society's attitudes to length of pregnancy  </li></ul>...
References  <ul><li>Johnson, R. & Taylor, W. (2010). Skills for midwifery practice. Edinburgh: Elsevier. </li></ul><ul><li...
http://www.flickr.com/photos/32323502@N00/428401602 Sarah Stewart:  [email_address] http://sarah-stewart.blogspot.com
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Induction of labour and artificial rupture of membranes

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Transcript of "Induction of labour and artificial rupture of membranes"

  1. 1. Induction of Labour...as a treatment for 'overdue' pregnancy Sarah Stewart 2011 http://www.flickr.com/photos/31929257@N00/2067613496
  2. 2. Definitions <ul><li>Term (as in a ‘normal’ and healthy gestation period): is from 37 weeks to 42 weeks. </li></ul><ul><li>Post dates: the pregnancy </li></ul><ul><li>has continued beyond the </li></ul><ul><li>decided due date ie. is over </li></ul><ul><li>40 weeks. </li></ul><ul><li>Post term: the pregnancy has continued beyond term ie. 42+ weeks. </li></ul><ul><li>Reed, 2010 </li></ul>http://www.flickr.com/photos/23524220@N00/3419755539
  3. 3. Most women birth between 41 and 42 weeks gestation http://www.flickr.com/photos/48819968@N00/84515824
  4. 4. In Australia... <ul><li>26.2% women have their labour induced </li></ul><ul><li>50% women are first time mums </li></ul><ul><li>No effect on stillbirth rate </li></ul><ul><li>Only half these women had normal birth </li></ul><ul><li>One third had c/section </li></ul><ul><li>Patterson et al, 2011 </li></ul>
  5. 5. Clinical guidelines recommend that women should be offered induction of labour between 41 and 42 weeks gestation NICE, 2008 http://www.flickr.com/photos/10249607@N04/3333062178
  6. 6. Expectant management <ul><li>Thought to be increased risk of fetal death if pregnancy lasts past 42 weeks but no clear evidence </li></ul><ul><li>500 IOL are needed to prevent 1 perinatal death </li></ul><ul><li>Evidence that there is increased risk of caesarean section and meconium-stained liquor after 41 weeks, but no increase in aspiration syndrome </li></ul><ul><li>Tracy, 2010 </li></ul>
  7. 7. Clinical guidelines recommend surveillance after 42 weeks eg ultrasound scan and CTG, but no evidence to support efficacy of this http://www.flickr.com/photos/75062596@N00/903573472
  8. 8. Membrane sweep <ul><li>Sweeping the membranes is effective in bringing on labour before 41 weeks </li></ul><ul><li>Causes discomfort, some bleeding and irregular contractions. </li></ul><ul><li>8 membrane sweep need to be carried out to prevent 1 medical IOL </li></ul><ul><li>NICE recommends membrane sweep between 40 and 41 weeks pregnancy </li></ul>
  9. 9. Homoeopathy No evidence to support its use http://www.flickr.com/photos/22198928@N00/841883683
  10. 10. Not enough evidence to support acupuncture http://www.flickr.com/photos/51035747113@N01/10920514
  11. 11. Risks of induction of labour <ul><li>Start of the 'cascade of intervention' </li></ul><ul><li>More likely to need epidural and have instrumental birth </li></ul><ul><li>Increased risk of fetal distress </li></ul><ul><li>50% increase risk of caesarean section in primiparous women for non-medical IOL </li></ul><ul><li>Tracey, 2010 </li></ul>http://farm6.static.flickr.com/5110/5619333529_4ff0fd7698.jpg
  12. 12. Contraindications <ul><li>Maternal refusal </li></ul><ul><li>Malpresentation </li></ul><ul><li>Previous major surgery – some would argue previous c-section </li></ul><ul><li>CPD </li></ul><ul><li>Cord prolapse </li></ul><ul><li>Active genital herpes </li></ul><ul><li>Placenta previa </li></ul><ul><li>Severely compromised baby </li></ul><ul><li>Breech baby </li></ul>
  13. 13. Induction of labour should not be started if Bishop Score is less than 6. A score of 8/9 indicates a “favourable” cervix
  14. 14. http://medchrome.com/major/gynaeobstr/bishop-score-and-modified-bishop-score/
  15. 15. Prostin <ul><li>Vaginal prostagladin gel is preferred method of IOL </li></ul><ul><li>Regime varies from hospital to hospital </li></ul><ul><li>May cause fetal distress, cause discomfort and take time for labour to start </li></ul><ul><li>Side effect may be hyper-stimulation </li></ul><ul><li>Placed in posterior fornice of cervix </li></ul>
  16. 16. Care of woman <ul><li>Informed consent </li></ul><ul><li>Assessment of woman including health, history, EDD and abdominal palpation </li></ul><ul><li>Assessment of baby's health – CTG </li></ul><ul><li>Bishop score </li></ul><ul><li>Correct administration of drug </li></ul><ul><li>Woman to rest on side for 30 mins. </li></ul><ul><li>CTG when contractions started until fetail health is confirmed </li></ul><ul><li>Documentation </li></ul><ul><li>Johnson and Taylor, 2010 </li></ul>
  17. 17. ARM <ul><li>Disrupts normal progression of labour and often leads to other interventions </li></ul><ul><li>Should not be used in “normal” labour </li></ul><ul><li>May shorten labour by 1 hour but increase labour pain leading to increased use of analgesia eg epidural </li></ul><ul><li>Increased risk of fetal distress, cord prolapse and c/section </li></ul>http://www.flickr.com/photos/scratch/249557231/
  18. 18. Contraindications <ul><li>High presenting head </li></ul><ul><li>Polyhydramnios </li></ul><ul><li>Preterm labour </li></ul><ul><li>Known vaginal infection </li></ul><ul><li>Positive HIV </li></ul><ul><li>Placenta previa </li></ul><ul><li>Vas previa </li></ul>http://www.flickr.com/photos/97328945@N00/4106718
  19. 19. Care of the woman <ul><li>Informed consent </li></ul><ul><li>Exclude contraindications </li></ul><ul><li>Maternal and fetal assessment </li></ul><ul><li>VE-rupture membranes with amnihock </li></ul><ul><li>Check fetal heart </li></ul><ul><li>Share findings with woman </li></ul><ul><li>Documentation </li></ul>http://www.flickr.com/photos/48819968@N00/64798520
  20. 20. Oxytocin <ul><li>Intravenous syntoconon is not as effective as vaginal prostagladin </li></ul><ul><li>Used with ARM is as effective as vaginal prostagladin </li></ul>http://www.flickr.com/photos/44124425616@N01/262522417
  21. 21. <ul><li>Once ARM is performed, there's no going back </li></ul><ul><li>IVI is very restrictive </li></ul><ul><li>Must be constantly monitored </li></ul><ul><li>Continuous CTG </li></ul><ul><li>Very careful adherence to syntocinon protocol </li></ul><ul><li>Very diligent documentation </li></ul>http://www.flickr.com/photos/40646519@N00/2318860224
  22. 22. Key points <ul><li>Midwife's role is to be advocate – be mindful of society's attitudes to length of pregnancy </li></ul><ul><li>Education during ante natal period so woman can make informed decision </li></ul><ul><li>Be clear about what research says and what it doesn't say </li></ul><ul><li>Induction of labour starts cascade of intervention </li></ul><ul><li>Very careful monitoring of mother and baby </li></ul><ul><li>Contemporaneous documentation </li></ul>
  23. 23. References <ul><li>Johnson, R. & Taylor, W. (2010). Skills for midwifery practice. Edinburgh: Elsevier. </li></ul><ul><li>NICE. (2008). Induction of labour . Retrieved from http://guidance.nice.org.uk/CG70 </li></ul><ul><ul><li>http://onlinelibrary.wiley.com/doi/10.1111/j.1479-828X.2011.01339.x/full </li></ul></ul><ul><li>Reed, R. (2010, September 16). Induction of Labour: balancing risks [web log message]. Retrieved from http://midwifethinking.com/2010/09/16/induction-of- labour-balancing-risks. </li></ul><ul><li>Reed, R. (2011, July 17). Induction: a step by step guide [web log message]. Retrieved from http://midwifethinking.com/2011/07/17/induction-a-step-by-step-guide/ </li></ul><ul><li>Tracey, S. (2010). Interventions in pregnancy, labour and birth. In S.Pairman, S.Tracy, </li></ul><ul><ul><li>C.Thorogood, & J. Pincombe (Eds.). Midwifery. Preparation for practice </li></ul></ul><ul><ul><li>(pp863-970). Edinburgh: Elsevier </li></ul></ul>
  24. 24. http://www.flickr.com/photos/32323502@N00/428401602 Sarah Stewart: [email_address] http://sarah-stewart.blogspot.com
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