Guidelines for induction
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The document provides guidelines for cervical ripening and labor induction. Key points include: - The modified Bishop score is the best tool for predicting successful induction outcomes. Cervical dilation carries the most weight. - Early amniotomy and oxytocin ("pop and pit") results in faster labor onset, shorter delivery time, and lower C-section rates compared to delayed amniotomy or oxytocin alone. - Outpatient cervical ripening with misoprostol (Cytotec) should allow assessment for admission or discharge by 8:30am following the induction attempt.
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Summary induction guidelines
The document provides guidelines for postterm induction, including:
1) Using the Bishop score, cervical dilation, parity, and EGA to determine timing of induction between 41w 0d-41w 6d
2) Favorable cervix for induction is a Bishop score of 6 or more
3) Risk of cesarean section is increased for Bishop score <5 or multiparous with cervix <2cm dilated/nulliparous with cervix <3-4cm dilated
Induction OF labor
This document provides information on induction and augmentation of labor. It discusses the definitions of labor, induction, and augmentation. It reviews trends showing rising rates of labor induction in the US. Common indications and contraindications for induction are outlined. Methods for evaluating maternal and fetal status prior to induction are described. Various pharmacologic and mechanical methods for cervical ripening are explained in detail. Finally, the document reviews protocols for labor induction and augmentation using oxytocin and associated risks and complications.
Use of foley catheter for cervical ripening
The document provides guidelines for using a Foley catheter to induce cervical ripening. A Foley catheter can apply mechanical pressure to the cervix to induce ripening. Its use is restricted to patients with intact membranes and an unfavorable cervix who are 35 weeks gestation or more, after consulting with a pediatrician. The document outlines the steps for proper placement and monitoring of the catheter.
Induction of labour (2)
This document discusses induction and augmentation of labor. It begins by defining induction of labor as artificially stimulating uterine contractions before the onset of labor, while augmentation refers to stimulating inadequate spontaneous contractions. The document then covers the structures and physiology of the cervix as it relates to ripening. It discusses various methods of assessing cervical status including Bishop's score and indications, contraindications, risks and prerequisites for labor induction. The document provides an overview of common methods used for cervical ripening and labor induction.
Induction of labor
This document provides an overview of induction of labor presented by Dr. Mansi Gupta. It defines induction and augmentation of labor and discusses gestational age classifications. The document outlines absolute and relative indications for induction as well as absolute and relative contraindications. It discusses elective induction of labor and recommendations from WHO on inducing labor in various situations. Evaluation before induction includes assessing maternal and fetal status and assigning a cervical scoring system. Methods for stabilizing induction and inducing labor in specific high-risk situations like IUGR, hypertension in pregnancy, and IUFD are presented.
Foley bulb
The document discusses the use of Foley bulbs for cervical ripening and labor induction. It finds that:
1) The modified Bishop score is the best tool for predicting vaginal delivery during labor induction, and cervical dilation is the most predictive variable.
2) A Foley bulb induction has been shown to be as effective as common pharmacological methods like misoprostol, with less risk of complications.
3) Distending the Foley bulb to 60-80ml is more effective for cervical ripening and shorter delivery times than only filling to 30ml. Using the bulb alone without additional drugs is sufficient.
Cervical ripening
1) Cervical ripening is used to induce labor when the cervix is unfavorable (Bishop score <6) and involves using agents like prostaglandins, misoprostol, or mechanical methods to soften and dilate the cervix.
2) Oxytocin is commonly used for labor induction when the cervix is favorable but careful monitoring is needed due to risks of uterine tachysystole and changes in the fetal heart rate.
3) While prostaglandins are more effective cervical ripening agents compared to oxytocin alone, all methods have risks and more research is still needed to evaluate some traditional induction methods.
induction of labor
This document discusses labor induction, including its definition, reasons it may be done, risks, preparation, methods, duration, and outcomes. Labor induction is a procedure used to stimulate uterine contractions before spontaneous labor begins. It carries some risks but may be recommended if the mother or baby's health is at risk late in pregnancy. Common induction methods include stripping the membranes, dilating the cervix, intravenous oxytocin, or rupturing the amniotic sac. The duration of induction can vary from a few hours to a few days depending on the individual case. Outcomes include successful vaginal birth in most cases but may require a C-section in some situations.
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Summary induction guidelines
The document provides guidelines for postterm induction, including:
1) Using the Bishop score, cervical dilation, parity, and EGA to determine timing of induction between 41w 0d-41w 6d
2) Favorable cervix for induction is a Bishop score of 6 or more
3) Risk of cesarean section is increased for Bishop score <5 or multiparous with cervix <2cm dilated/nulliparous with cervix <3-4cm dilated
Induction OF labor
This document provides information on induction and augmentation of labor. It discusses the definitions of labor, induction, and augmentation. It reviews trends showing rising rates of labor induction in the US. Common indications and contraindications for induction are outlined. Methods for evaluating maternal and fetal status prior to induction are described. Various pharmacologic and mechanical methods for cervical ripening are explained in detail. Finally, the document reviews protocols for labor induction and augmentation using oxytocin and associated risks and complications.
Use of foley catheter for cervical ripening
The document provides guidelines for using a Foley catheter to induce cervical ripening. A Foley catheter can apply mechanical pressure to the cervix to induce ripening. Its use is restricted to patients with intact membranes and an unfavorable cervix who are 35 weeks gestation or more, after consulting with a pediatrician. The document outlines the steps for proper placement and monitoring of the catheter.
Induction of labour (2)
This document discusses induction and augmentation of labor. It begins by defining induction of labor as artificially stimulating uterine contractions before the onset of labor, while augmentation refers to stimulating inadequate spontaneous contractions. The document then covers the structures and physiology of the cervix as it relates to ripening. It discusses various methods of assessing cervical status including Bishop's score and indications, contraindications, risks and prerequisites for labor induction. The document provides an overview of common methods used for cervical ripening and labor induction.
Induction of labor
This document provides an overview of induction of labor presented by Dr. Mansi Gupta. It defines induction and augmentation of labor and discusses gestational age classifications. The document outlines absolute and relative indications for induction as well as absolute and relative contraindications. It discusses elective induction of labor and recommendations from WHO on inducing labor in various situations. Evaluation before induction includes assessing maternal and fetal status and assigning a cervical scoring system. Methods for stabilizing induction and inducing labor in specific high-risk situations like IUGR, hypertension in pregnancy, and IUFD are presented.
Foley bulb
The document discusses the use of Foley bulbs for cervical ripening and labor induction. It finds that:
1) The modified Bishop score is the best tool for predicting vaginal delivery during labor induction, and cervical dilation is the most predictive variable.
2) A Foley bulb induction has been shown to be as effective as common pharmacological methods like misoprostol, with less risk of complications.
3) Distending the Foley bulb to 60-80ml is more effective for cervical ripening and shorter delivery times than only filling to 30ml. Using the bulb alone without additional drugs is sufficient.
Cervical ripening
1) Cervical ripening is used to induce labor when the cervix is unfavorable (Bishop score <6) and involves using agents like prostaglandins, misoprostol, or mechanical methods to soften and dilate the cervix.
2) Oxytocin is commonly used for labor induction when the cervix is favorable but careful monitoring is needed due to risks of uterine tachysystole and changes in the fetal heart rate.
3) While prostaglandins are more effective cervical ripening agents compared to oxytocin alone, all methods have risks and more research is still needed to evaluate some traditional induction methods.
induction of labor
This document discusses labor induction, including its definition, reasons it may be done, risks, preparation, methods, duration, and outcomes. Labor induction is a procedure used to stimulate uterine contractions before spontaneous labor begins. It carries some risks but may be recommended if the mother or baby's health is at risk late in pregnancy. Common induction methods include stripping the membranes, dilating the cervix, intravenous oxytocin, or rupturing the amniotic sac. The duration of induction can vary from a few hours to a few days depending on the individual case. Outcomes include successful vaginal birth in most cases but may require a C-section in some situations.
Induction of lobour
This document discusses induction of labor, including its definition, indications, contraindications, methods, and risks. It defines induction of labor as planned initiation of uterine contractions before spontaneous onset. Common indications include prolonged pregnancy and fetal growth restriction. Contraindications include placenta previa and severe fetal compromise. Methods discussed include membrane stripping, amniotomy, prostaglandins like misoprostol and dinoprostone, and oxytocin. Risks of induction include greater pain, uterine hyperstimulation, cord prolapse, and potential need for C-section if induction fails. The document provides three scenarios involving induction and asks for opinions on indications and complications.
Induction of labour
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
No 107 induction of labor acog 2009
- More than 22% of labors in the US are induced. The goal of induction is to stimulate contractions before spontaneous labor begins when the benefits outweigh the risks of continuing the pregnancy.
- Methods for cervical ripening include mechanical methods like dilators and prostaglandins. Misoprostol can be used intravaginally, orally, or sublingually for ripening and induction.
- Once the cervix is ripe, oxytocin is commonly used to induce contractions. Other methods include membrane stripping, amniotomy, and nipple stimulation. The risks and benefits of each method should be considered.
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IOL..first mentioned HIPPOCRATES
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MOST EFFECTIVE INTERVENTIONS IN MODERN OBSTETRICS.
โEXACT KNOWLEDGE ON WHOM,WHEN,WHERE HOW HAS BEEN LACKINGโ
NO CONSENSUS BASED ON LARGE RCTs
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This document discusses induction of labor and provides definitions, objectives, indications, contraindications, risks, prerequisites, and methods of induction. It defines grades of evidence and levels of recommendations. The main methods discussed are natural/non-medical, mechanical (laminaria, balloons), surgical (stripping membranes, amniotomy), and pharmacological (misoprostol, mifepristone, oxytocin, prostaglandin E2). It provides details on administration and risks for each method. The goal is to create awareness of appropriate induction techniques and select the best method for each individual patient.
Induction of Labour
This document discusses the definition, indications, timing, criteria, and contraindications of induced labor. It notes that induced labor is initiated before spontaneous labor to achieve delivery when the benefits outweigh the risks of continuing the pregnancy, such as in cases of post-dates pregnancy, preeclampsia, diabetes, or fetal compromise. The timing depends on the indication, and criteria include confirmed dates and no acute fetal distress. Contraindications include conditions that could increase risks during a vaginal delivery. District hospitals have limits on the number of prostaglandins that can be used to induce labor without specialist consultation.
Induction Lecture Fmdrl
This document discusses cervical ripening and labor induction. It provides indications and contraindications for labor induction, as well as factors that predict success. Methods for cervical ripening include prostaglandins and mechanical/alternative methods. Oxytocin and prostaglandins like misoprostol are common agents for labor induction, but they carry risks like uterine hyperstimulation and abnormal fetal heart rate patterns. Careful dosing and monitoring are important when inducing labor.
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Sri Lanka
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This document discusses induction of labor, including definitions, purposes, indications, contraindications, and methods. The key methods of medical induction discussed are prostaglandins like dinoprostone and misoprostol, oxytocin, and mifepristone. Prostaglandins work to ripen the cervix and stimulate contractions through local effects on cervical collagen and myometrium. Oxytocin stimulates contractions through receptor-mediated pathways. Mifepristone is a progesterone antagonist that blocks progesterone receptors to ripen the cervix. The document compares these methods and provides dosing and administration details.
Induction of labour2013
This document provides guidelines on the induction of labour. It defines induction of labour and related terms. Acceptable indications for induction include preeclampsia and maternal disease. Unacceptable indications are suspected fetal macrosomia and patient/provider convenience.
Prior to induction, an assessment including Bishop score should be done to determine likelihood of success. Options for cervical ripening include mechanical methods like Foley catheters and pharmacological agents like prostaglandins and misoprostol. Oxytocin is recommended for establishing labour once the cervix is favorable. Risks of different agents are outlined. Guidelines recommend timing and monitoring of inductions.
Induction of labor
Induction of labor is the artificial initiation of labor before spontaneous onset to deliver the fetus and placenta. It may be indicated for maternal or fetal reasons. Preinduction assessment involves evaluating the maternal and fetal condition, discussing techniques and alternatives, and obtaining consent. For an unfavorable cervix, cervical ripening methods like prostaglandins or mechanical dilators are used first. With a favorable cervix, amniotomy or oxytocin infusion can be used. Monitoring during induction includes continuous fetal monitoring. Potential complications include abnormal uterine contractions, failed induction, cord prolapse, uterine rupture, and hyponatremia.
Induction of labor& pain reief inlabor for undergraduate
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This document discusses induction of labor and pain relief during labor. It provides information on indications for labor induction, methods of cervical ripening and labor induction, risks of induction, and factors to consider. It also examines different types of pain relief during labor including non-pharmacological options like relaxation, TENS, and hydrotherapy as well as pharmacological options like opiates, inhalational anesthesia, and epidurals. The ideal analgesic is discussed as being easy to administer, safe for mother and baby, and not interfering with uterine contractions or mobility.ย
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This document discusses induction of labour for pregnancies that have gone past their due dates. It defines terms like term, post-dates, and post-term pregnancy. It also discusses clinical guidelines around offering induction between 41-42 weeks and risks of going past 42 weeks. Membrane sweeps and different methods of induction like prostaglandins and ARM are covered along with their risks, benefits, and contraindications. Close monitoring of mothers and babies during induction is emphasized.
Presentaion induction of labour
This document discusses induction of labor, which is defined as artificially stimulating uterine contractions before spontaneous labor begins in order to achieve delivery. The document outlines indications for induction such as pregnancy-induced hypertension and post-maturity. It also lists contraindications and risks to induction. Methods of induction discussed include mechanical methods like membrane sweeping, medical methods using prostaglandins and oxytocin, and surgical methods like artificial rupture of membranes. Criteria for induction and the Bishop score for assessing cervical ripening are also presented.
Induction of labor
This document discusses induction of labor and augmentation of labor. Induction of labor is artificially initiating uterine contractions before their spontaneous onset, while augmentation is attempting to assist or accelerate labor that has begun normally. Common indications for induction include preeclampsia, PROM, post-term pregnancy, and fetal issues like IUFD or severe IUGR. Contraindications include severe CPD, major placenta previa, and active genital herpes. Methods of induction include cervical ripening using prostaglandins or dilators followed by oxytocin or amniotomy to induce contractions. Oxytocin administration begins at 1 mU/min and is increased every 30 minutes until effective contractions occur.
Induction of labour
The document discusses guidelines for induction of labor including:
1) Common reasons for induction of labor and risks/benefits that should be discussed with patients. Patients should be informed of alternative options if they decline induction.
2) What to discuss at the 38 week visit including membrane sweeps and the timing of induction between 41-42 weeks or for other reasons like preterm rupture of membranes.
3) Methods of induction including membrane sweeps, pharmacological agents like prostaglandins, amniotomy, and Foley catheter placement. Risks of induction like uterine hyperstimulation and failed induction are also addressed.
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Induction of labour
The document discusses induction of labour, including its definition, mechanisms, indications, contraindications, methods, and complications. Some key points include:
- Induction of labour is the artificial initiation of labour prior to its spontaneous onset.
- Common methods include membrane sweeping, amniotomy, prostaglandins like misoprostol and dinoprostone, and oxytocin administration.
- Indications include post-term pregnancy, pre-eclampsia, diabetes, and fetal growth restriction. Contraindications include malpresentations and previous uterine scarring.
- Factors like maternal and fetal well-being as well as cervical status via Bishop score are assessed prior to induction.
- Comp
Induction of Labour
This document discusses the induction of labor. It begins by defining induction of labor as artificially initiating uterine contractions before their spontaneous onset, leading to cervical dilation and delivery. Common indications for induction include prolonged pregnancy past 41 weeks, maternal health conditions, and fetal health concerns. A full assessment of dates, fetal position, and cervical condition is recommended before induction. Common methods discussed include membrane sweeping, prostaglandins administered vaginally or orally, misoprostol, and oxytocin infusion. Risks of failed induction or complications are also outlined.
When to schedule posterm induction
The document provides guidelines for postterm induction, including:
1) Using the Bishop score, cervical dilation, parity, and EGA to determine when to schedule inductions between 41w 0d-41w 6d.
2) Scheduling outpatient Cytotec inductions in the evenings staggered to allow for assessment and additional dosing if needed.
3) Scheduling inpatient Pitocin inductions staggered in the mornings.
4) Favorable criteria for induction include Bishop score of 6 or more and cervical dilation of 3-4cm for nulliparous and 2cm for multiparous patients.
Induction summary
This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
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Induction of lobour
This document discusses induction of labor, including its definition, indications, contraindications, methods, and risks. It defines induction of labor as planned initiation of uterine contractions before spontaneous onset. Common indications include prolonged pregnancy and fetal growth restriction. Contraindications include placenta previa and severe fetal compromise. Methods discussed include membrane stripping, amniotomy, prostaglandins like misoprostol and dinoprostone, and oxytocin. Risks of induction include greater pain, uterine hyperstimulation, cord prolapse, and potential need for C-section if induction fails. The document provides three scenarios involving induction and asks for opinions on indications and complications.
Induction of labour
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Guidelines on induction of labour
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prostaglandins for induction of labour
Bishop score
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mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
No 107 induction of labor acog 2009
- More than 22% of labors in the US are induced. The goal of induction is to stimulate contractions before spontaneous labor begins when the benefits outweigh the risks of continuing the pregnancy.
- Methods for cervical ripening include mechanical methods like dilators and prostaglandins. Misoprostol can be used intravaginally, orally, or sublingually for ripening and induction.
- Once the cervix is ripe, oxytocin is commonly used to induce contractions. Other methods include membrane stripping, amniotomy, and nipple stimulation. The risks and benefits of each method should be considered.
An update INDUCTION OF LABOR : WHO, WHEN, HOW ,WHERE & OUTCOME?
IOL..first mentioned HIPPOCRATES
The โฆNIPPLE STIMULATION OR MECHANICAL METHODS
NOWโฆ
MOST USED
MOST EFFECTIVE INTERVENTIONS IN MODERN OBSTETRICS.
โEXACT KNOWLEDGE ON WHOM,WHEN,WHERE HOW HAS BEEN LACKINGโ
NO CONSENSUS BASED ON LARGE RCTs
Ind madina
This document discusses induction of labor and provides definitions, objectives, indications, contraindications, risks, prerequisites, and methods of induction. It defines grades of evidence and levels of recommendations. The main methods discussed are natural/non-medical, mechanical (laminaria, balloons), surgical (stripping membranes, amniotomy), and pharmacological (misoprostol, mifepristone, oxytocin, prostaglandin E2). It provides details on administration and risks for each method. The goal is to create awareness of appropriate induction techniques and select the best method for each individual patient.
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This document discusses the definition, indications, timing, criteria, and contraindications of induced labor. It notes that induced labor is initiated before spontaneous labor to achieve delivery when the benefits outweigh the risks of continuing the pregnancy, such as in cases of post-dates pregnancy, preeclampsia, diabetes, or fetal compromise. The timing depends on the indication, and criteria include confirmed dates and no acute fetal distress. Contraindications include conditions that could increase risks during a vaginal delivery. District hospitals have limits on the number of prostaglandins that can be used to induce labor without specialist consultation.
Induction Lecture Fmdrl
This document discusses cervical ripening and labor induction. It provides indications and contraindications for labor induction, as well as factors that predict success. Methods for cervical ripening include prostaglandins and mechanical/alternative methods. Oxytocin and prostaglandins like misoprostol are common agents for labor induction, but they carry risks like uterine hyperstimulation and abnormal fetal heart rate patterns. Careful dosing and monitoring are important when inducing labor.
Induction of labour
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Sri Lanka
Medical induction of labour
This document discusses induction of labor, including definitions, purposes, indications, contraindications, and methods. The key methods of medical induction discussed are prostaglandins like dinoprostone and misoprostol, oxytocin, and mifepristone. Prostaglandins work to ripen the cervix and stimulate contractions through local effects on cervical collagen and myometrium. Oxytocin stimulates contractions through receptor-mediated pathways. Mifepristone is a progesterone antagonist that blocks progesterone receptors to ripen the cervix. The document compares these methods and provides dosing and administration details.
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This document provides guidelines on the induction of labour. It defines induction of labour and related terms. Acceptable indications for induction include preeclampsia and maternal disease. Unacceptable indications are suspected fetal macrosomia and patient/provider convenience.
Prior to induction, an assessment including Bishop score should be done to determine likelihood of success. Options for cervical ripening include mechanical methods like Foley catheters and pharmacological agents like prostaglandins and misoprostol. Oxytocin is recommended for establishing labour once the cervix is favorable. Risks of different agents are outlined. Guidelines recommend timing and monitoring of inductions.
Induction of labor
Induction of labor is the artificial initiation of labor before spontaneous onset to deliver the fetus and placenta. It may be indicated for maternal or fetal reasons. Preinduction assessment involves evaluating the maternal and fetal condition, discussing techniques and alternatives, and obtaining consent. For an unfavorable cervix, cervical ripening methods like prostaglandins or mechanical dilators are used first. With a favorable cervix, amniotomy or oxytocin infusion can be used. Monitoring during induction includes continuous fetal monitoring. Potential complications include abnormal uterine contractions, failed induction, cord prolapse, uterine rupture, and hyponatremia.
Induction of labor& pain reief inlabor for undergraduate
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Induction of labour and artificial rupture of membranes
This document discusses induction of labour for pregnancies that have gone past their due dates. It defines terms like term, post-dates, and post-term pregnancy. It also discusses clinical guidelines around offering induction between 41-42 weeks and risks of going past 42 weeks. Membrane sweeps and different methods of induction like prostaglandins and ARM are covered along with their risks, benefits, and contraindications. Close monitoring of mothers and babies during induction is emphasized.
Presentaion induction of labour
This document discusses induction of labor, which is defined as artificially stimulating uterine contractions before spontaneous labor begins in order to achieve delivery. The document outlines indications for induction such as pregnancy-induced hypertension and post-maturity. It also lists contraindications and risks to induction. Methods of induction discussed include mechanical methods like membrane sweeping, medical methods using prostaglandins and oxytocin, and surgical methods like artificial rupture of membranes. Criteria for induction and the Bishop score for assessing cervical ripening are also presented.
Induction of labor
This document discusses induction of labor and augmentation of labor. Induction of labor is artificially initiating uterine contractions before their spontaneous onset, while augmentation is attempting to assist or accelerate labor that has begun normally. Common indications for induction include preeclampsia, PROM, post-term pregnancy, and fetal issues like IUFD or severe IUGR. Contraindications include severe CPD, major placenta previa, and active genital herpes. Methods of induction include cervical ripening using prostaglandins or dilators followed by oxytocin or amniotomy to induce contractions. Oxytocin administration begins at 1 mU/min and is increased every 30 minutes until effective contractions occur.
Induction of labour
The document discusses guidelines for induction of labor including:
1) Common reasons for induction of labor and risks/benefits that should be discussed with patients. Patients should be informed of alternative options if they decline induction.
2) What to discuss at the 38 week visit including membrane sweeps and the timing of induction between 41-42 weeks or for other reasons like preterm rupture of membranes.
3) Methods of induction including membrane sweeps, pharmacological agents like prostaglandins, amniotomy, and Foley catheter placement. Risks of induction like uterine hyperstimulation and failed induction are also addressed.
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induction of labour, artificial rupture of membranes, ARM, BISHOP SCORE, CERVICAL REPINING, MECHANICAL METHOD, AMINOTOMY, HYPERSTIMULATION, FAILED INDUCTION, MEDICAL MANAGEMENT, PGE2, OXYTOCIN,
Induction of labour
The document discusses induction of labour, including its definition, mechanisms, indications, contraindications, methods, and complications. Some key points include:
- Induction of labour is the artificial initiation of labour prior to its spontaneous onset.
- Common methods include membrane sweeping, amniotomy, prostaglandins like misoprostol and dinoprostone, and oxytocin administration.
- Indications include post-term pregnancy, pre-eclampsia, diabetes, and fetal growth restriction. Contraindications include malpresentations and previous uterine scarring.
- Factors like maternal and fetal well-being as well as cervical status via Bishop score are assessed prior to induction.
- Comp
Induction of Labour
This document discusses the induction of labor. It begins by defining induction of labor as artificially initiating uterine contractions before their spontaneous onset, leading to cervical dilation and delivery. Common indications for induction include prolonged pregnancy past 41 weeks, maternal health conditions, and fetal health concerns. A full assessment of dates, fetal position, and cervical condition is recommended before induction. Common methods discussed include membrane sweeping, prostaglandins administered vaginally or orally, misoprostol, and oxytocin infusion. Risks of failed induction or complications are also outlined.
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Similar to Guidelines for induction
When to schedule posterm induction
The document provides guidelines for postterm induction, including:
1) Using the Bishop score, cervical dilation, parity, and EGA to determine when to schedule inductions between 41w 0d-41w 6d.
2) Scheduling outpatient Cytotec inductions in the evenings staggered to allow for assessment and additional dosing if needed.
3) Scheduling inpatient Pitocin inductions staggered in the mornings.
4) Favorable criteria for induction include Bishop score of 6 or more and cervical dilation of 3-4cm for nulliparous and 2cm for multiparous patients.
Induction summary
This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
Induction summary
This document provides guidelines for induction of labor, including:
1. Recommending inpatient and outpatient Cytotec inductions arrive at 7:00 PM to facilitate admission/discharge decisions and additional Cytotec doses if needed.
2. Inpatient Pitocin-only inductions should arrive at 6:00 AM to start Pitocin before 7:00 AM.
3. Favorable criteria for induction include a modified Bishop score of 6 or more and cervical dilation of 3-4 cm for nulliparous patients.
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accounts for approximately 18% to 20% of perinatal deaths in the United States.
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Vaginal birth after cesarean section (VBAC) is the term applied to women who undergo vaginal delivery following cesarean delivery in a prior pregnancy. Patients desiring VBAC delivery undergo a trial of labor (TOL) or trial of labor after cesarean section (TOLAC).
Breech in labour
This document provides guidelines for the induction of labor and management of certain complications during labor and delivery. It addresses indications for induction, recommended methods, monitoring requirements, management of failed induction, and special considerations for breech presentation and intrauterine fetal death. Factors regarding unfavorable breech delivery and contraindications are also outlined.
Breech in labour
This document provides guidelines for breech delivery, intrauterine fetal death, and induction of labor. It discusses recommended procedures for diagnosing and delivering breech presentations, managing intrauterine fetal death, and inducing labor through membrane sweeping and pharmacological methods like vaginal prostaglandins. Factors that make vaginal breech delivery or induction inadvisable are also outlined. Continuous fetal monitoring is recommended during labor induction and procedures to assess progress are described.
Vbacs
This document discusses the history and risks/benefits of vaginal birth after cesarean (VBAC) versus elective repeat cesarean section. It notes that while VBAC was originally encouraged due to risks of multiple c-sections, safety concerns led to declining VBAC rates. VBAC carries risks of uterine rupture but reduces risks of respiratory issues compared to repeat c-section. Proper patient selection and access to emergency c-section are important to support a planned VBAC attempt. The risks and benefits should be discussed thoroughly to help each woman make an informed decision.
Medically Indicated Deliveries Before 39 weeks
A presentation on Medically Indicated Deliveries Before 39 weeks.
Includes updated information from ACOG.
Medically indicated late-preterm and early-term deliveries. Committee Opinion No. 560. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:908โ10.
Chapter ii
This document discusses abnormal labor and delivery, including induction and augmentation of labor. It describes various methods for inducing labor, including medical methods using oxytocin or prostaglandins, and surgical methods like amniotomy. It lists many indications for inducing labor. It also discusses factors that make induction more likely to be successful, like cervical status and gestational age. Complications of induction and prolonged labor are outlined. Nursing care during induced and prolonged labor is also summarized.
Evidence based induction of labor
This document summarizes guidelines for induction of labor from several sources. It discusses best practices for confirming gestational age, considering medical indications, accepting maternal request, proceeding over maternal refusal, timing of induction, and monitoring during labor induction. It also provides evidence-based recommendations on methods of induction such as membrane sweeping, cervical assessments, amniotomy, oxytocin administration, and fetal monitoring. The document synthesizes evidence from multiple systematic reviews and clinical guidelines to provide comprehensive guidance on safe and effective labor induction practices.
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Medical termination of pregnancy can be performed for indications such as risk to the life or health of the pregnant woman, fetal abnormalities, or pregnancy due to rape or contraceptive failure. Termination can be done by registered medical practitioners up to 20 weeks gestation with the woman's consent. First trimester abortions involve medical methods using mifepristone and misoprostol or surgical vacuum aspiration. Midtrimester termination from 13-15 weeks uses misoprostol or dilation and evacuation, while from 16-20 weeks involves hypertonic solutions or hysterotomy. Complications can include infection, bleeding, and injury.
PREMATURE RUPTURE OF MEMBRAMES AND PRETER LABOR
1) Preterm labor is defined as labor beginning before 37 weeks of gestation and is a leading cause of neonatal morbidity and mortality.
2) The cause of preterm labor is idiopathic in 50% of cases, but risk factors include maternal age under 18 or over 40, low socioeconomic status, infections, cervical insufficiency, and prior preterm births.
3) Signs and symptoms of preterm labor include painful or painless uterine contractions, pelvic pressure, and increased vaginal discharge. Diagnosis is based on regular contractions and cervical changes.
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This document discusses various topics related to midwifery including prolonged pregnancy, induction of labor, abnormal labor, obstetric emergencies, obstetric operations, malpositions and malpresentations. It provides definitions and details regarding prolonged pregnancy risks and management. Methods of labor induction using prostaglandins, oxytocin, membrane sweeping, and amniotomy are described. Complications of induction methods and the importance of monitoring mothers and fetuses during induction are also outlined.
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Kpsc diabetes in pregnancy pathway 8.6.2012
The document outlines guidelines for managing diabetes in pregnancy across medical centers. It discusses:
1. Individual centers being graded on compliance with performing HbA1c tests on all prenatal patients and FBS tests for GDM patients at 6 weeks postpartum. Bonuses may be tied to these performance measures.
2. Risk stratification of patients into low, medium, and high risk groups based on diabetes history and control. This determines interventions like medication management and fetal monitoring.
3. Screening all prenatal patients for GDM risk and providing diabetes education. High risk patients receive early glucose testing while low risk patients are tested at 24-28 weeks.
4. Postpartum follow-up
Economy
The document discusses issues with the current scheduling system including too many changes and vague requests. It proposes implementing scheduled cesarean sections on call days to improve efficiency by ensuring the primary surgeon performs the surgery and eliminating wasted time. This could add 30 hours of clinic access per month. Some providers argue they are too busy, but deliveries have decreased so scheduling cesareans this way could help protect staffing levels. No more than 2 cesareans would be scheduled per provider per call day.
Twins clinical management 2012
This document provides guidelines for managing twin pregnancies, including determining chorionicity and amnioticity. It recommends that all twins undergo an NT ultrasound before 14 weeks to validate chorionicity/amnionicity and detect early complications. Management of monochorionic twins requires more intensive surveillance due to increased risks of complications affecting fetal growth and well-being. Dichorionic twins generally require less frequent monitoring while monochorionic twins should be monitored more closely, with delivery planned before 37 weeks.
New Progesterone Guideline for Preterm labor and incidental shortened cervix
This document summarizes recommendations for using progesterone to prevent preterm birth based on a woman's history and cervical length. It recommends 17-hydroxyprogesterone caproate injections weekly from 16-20 weeks until 36 weeks for women with a prior spontaneous preterm birth. For women without a prior preterm birth but an incidental short cervical length of 10-20mm before 24 weeks, it recommends daily vaginal progesterone until 36 weeks. Safety follow-up of children exposed to 17-hydroxyprogesterone caproate in clinical trials found no differences compared to placebo.
Medication 53333-phpapp02
The document discusses improving patient satisfaction scores related to communication about medications at Riverside Medical Center's maternity service. The goal is to increase the HCAHPS medication communication score from 66% to 75% by December 2012 and 85% by June 2013. This will be achieved through education of providers, patients, and staff. Providers will be educated on medications through meetings and flashcards. Patients will receive verbal and written information about new medications. Staff will track medication discussions on patient care boards. Progress will be measured through education documentation and eventual HCAHPS scores.
Hcahps score trends in the past 4 years
This document shows trends in patient experience scores over 4 years from 2008-2012 at KP Riverside Medical Center based on the HCAHPS survey. The line graphs depict scores for various measures related to nurse and doctor communication, responsiveness of staff, pain management, medication communication, discharge processes, cleanliness and quietness. Scores fluctuate over time but generally remain between 60-90% for most measures.
Coccidioidomycosis in pregnancy
This document discusses coccidioidomycosis (Valley fever) during pregnancy. It notes that the infection is more severe when acquired during pregnancy, especially in the third trimester, and that the use of azole antifungals during pregnancy can be teratogenic. It reviews literature on cases of coccidioidomycosis in pregnancy and the effect of sex hormones on fungal growth. It also discusses the risk of birth defects from azole exposure during pregnancy, specifically the Antley-Bixler syndrome. The document provides recommendations for managing coccidioidomycosis in pregnant women based on their infection status and trimester.
Von willebrands disease
Von Willebrand disease is the most common inherited bleeding disorder caused by mutations that decrease or impair von Willebrand factor, which promotes platelet adhesion and clotting. It ranges from mild to severe. Type I is the most common form with a quantitative deficiency, while type II has qualitative defects affecting function. Treatment involves desmopressin, which releases stored VWF, or VWF replacement for refractory or severe cases. Careful management is needed around procedures and delivery to maintain adequate VWF and factor VIII levels through replacement to prevent bleeding.
Hini2012 update
The document provides guidelines for evaluating and managing patients with influenza-like illness (ILI) during pregnancy. It describes the symptoms of ILI and H1N1 flu. Patients with mild ILI symptoms and no risk factors can be treated as outpatients, while those with concerning signs, comorbidities, or symptom progression warrant further evaluation and treatment including Tamiflu and possible hospitalization.
Pph share drive
This document discusses the management of postpartum hemorrhage (PPH). It defines PPH and risk factors. It outlines the roles and responsibilities of the nursing team in responding to a PPH. It also details the differential diagnosis, initial resuscitation steps, and therapeutic escalation based on the severity of bleeding and patient's response to treatment. The goal is to recognize and treat PPH early through decisive clinical response and prevent complications like shock.
Late preterm delivery
Late preterm infants born between 34 0/7 and 36 6/7 weeks have higher rates of morbidity than full term infants. During the initial birth hospitalization, late preterm infants are more likely to experience conditions like temperature instability, hypoglycemia, respiratory distress, and jaundice. The risks are even higher for late preterm infants whose mothers have complications like hypertension, diabetes, bleeding, or infections. Readmission rates within the first year are also higher, around 15%, for late preterm infants compared to full term infants. Late preterm infants also have higher mortality rates within the first year of life and are at greater risk for long-term neurodevelopmental issues.
Insulin resistance and pcos
The document summarizes key findings from a review of literature on polycystic ovary syndrome (PCOS). It finds that the most consistent predictors of PCOS are hyperandrogenemia (high levels of "male" hormones) in 60-80% of cases, hirsutism (excess hair growth) in 60% of cases, and polycystic ovaries in 75% of cases. It also discusses debates around definitions of PCOS and relationships with insulin resistance.
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Hyperemesis Gravidarum is a condition characterized by persistent and severe nausea and vomiting during pregnancy. It can lead to weight loss of 5% or more of the woman's pre-pregnancy weight and the presence of ketones in the urine. Potential causes include multiple gestation, trophoblastic disease, or genetic conditions like trisomy 21. Treatment focuses on managing symptoms, avoiding triggers, dietary changes, medications like antihistamines, phenothiazines, and serotonin antagonists. Intravenous fluids and supplementation of vitamins and minerals may be needed to address nutritional deficiencies and prevent complications like Wernicke's encephalopathy. Enteral nutrition through nasojejunal feeding tubes is preferable to parent
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The document summarizes changes to CDC guidelines for prevention of early-onset group B streptococcal (GBS) disease. Key changes include: expanded laboratory detection options for GBS; revised thresholds for reporting GBS in urine cultures; clarified definitions of adequate antibiotic prophylaxis and high risk for anaphylaxis; and adjustments to neonatal management algorithms to reduce unnecessary evaluations. Guidelines emphasize using cefazolin over clindamycin or vancomycin when possible for penicillin-allergic women.
Foley bulb
The document discusses the use of Foley bulbs for cervical ripening and labor induction. It finds that:
1) A Foley bulb induction is as effective as common prostaglandin methods like misoprostol for cervical ripening and inducing labor, with fewer risks of complications.
2) Inflating the Foley bulb to 60-80ml is more effective for cervical dilation and shorter delivery times than only inflating to 30ml.
3) Using a Foley bulb alone without additional prostaglandins or oxytocin is equally effective while avoiding increased need for pain management.
Fht interpretation & management
This document provides guidelines for the management and interpretation of intrapartum fetal heart rate tracings. It discusses important factors to consider when interpreting tracings such as gestational age, maternal conditions, and fetal conditions. It describes the physiology underlying different fetal heart rate patterns. It also presents the NICHD nomenclature for standardized description of tracings, including definitions for baseline rate, variability, accelerations, and decelerations. Tracings are categorized as Category I, II, or III based on patterns that reflect fetal acid-base status. Category I tracings are normal while Category III tracings indicate abnormal fetal status and need for prompt evaluation and treatment.
Asymptomatic short cervix and vaginanal, progesterone
1. Vaginal progesterone reduces preterm birth in women with an asymptomatic sonographic short cervix in the midtrimester. The meta-analysis found vaginal progesterone once daily from identification of a short cervix <25mm until 37 weeks decreases preterm birth <33 weeks by 45% and decreases neonatal morbidity and mortality.
2. Treatment with vaginal progesterone was associated with significant reductions in preterm birth before 28 weeks, 33 weeks, and 35 weeks as well as composite neonatal morbidity and mortality.
3. There were no significant differences in adverse maternal events or congenital anomalies between the vaginal progesterone and placebo groups.
Prevention of pertussis
The document discusses pertussis (whooping cough) prevention, treatment, and epidemiology. It provides guidelines for vaccinating pregnant women and new mothers with Tdap to prevent transmission to infants. It describes the symptoms and phases of pertussis, recommends antibiotic treatment and prophylaxis, and defines close contacts for evaluation and post-exposure prophylaxis. Pertussis cases are increasing significantly in California and infants are most at risk for severe disease.
Magnesium sulfate
The document discusses evidence that magnesium sulfate administered to mothers at risk of preterm birth reduces the risk of cerebral palsy in infants. Several large randomized controlled trials and meta-analyses involving over 15,000 women found magnesium sulfate decreased the risk of cerebral palsy without increasing mortality. The number needed to treat to prevent one case of cerebral palsy is estimated at 63 women. The document also describes a modified magnesium sulfate neuroprotection protocol used at Riverside Hospital for imminent preterm deliveries between 23 and 33 weeks.
Labor down
1) Studies on delayed pushing, also called "laboring down", have shown mixed results, with the main consistent benefit being a reduced need for operative vaginal deliveries in nulliparous women with epidurals.
2) Delaying pushing can prolong the second stage of labor by about an hour and may increase risks like chorioamnionitis with delays over 1 hour.
3) Delayed pushing may be considered for nulliparous women with epidurals who do not have an urge to push and the fetal head is not yet at station +2, as long as the fetal heart rate is reassuring and no other risk factors exist. The delay should not exceed 90 minutes.
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Guidelines for induction
- 1. GUIDELINES for INDUCTION MODIFIED BISHOP SCORE INDUCTION ETIQUETTE WHAT ARE THE REVISED GUIDELINES CYTOTEC PHARMACOKINETICS ACTIVE MANAGEMENT INPATIENT vs OUTPATIENT HOW TO USE A FOLEY BULB CERVIDIL NOT RECOMMENDED
- 2. MODIFIED BISHOP SCORE ONLY 3 VARIABLES Positive Predictive Value for Delivery Equals or Exceeds Original 5 variable Bishop Score CERVICAL DILATION IS THE STRONGEST PREDICTOR AND CARRIES DOUBLE WEIGHT Obstet Gynecol 1982;60:137
- 4. DILATION SCORE 0 0 cm 2 1-2 cm 4 3-4 cm 6 >4 cm CERVICAL LENGTH SCORE By digital PALPATION 0 3 cm 1 2 cm 2 1 cm 3 0 cm STATION SCORE In relation to spines 0 -3 1 -2 2 -1/O 3 + 1/+2
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