Induction of labour and artificial rupture of membranes
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Induction of labour and artificial rupture of membranes

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

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