Induction of labor - Obstetric

 

Here is the summary of IOL and more information do scroll down to understand further details. 

Notes:

• IOL : Induction Of Labor
• GDM: Gestational Diabetes Mellitus
• PROM: Premature Rupture of Membrane
• IUD: Intrauterine Death
• IUGR: Intrauterine Growth Restriction
• LGA: Large Gestational Age
• NRVE: Next Review Vaginal Examination
• NRC: Next Review Contraction
• LSCS: lower segment caesarean Section

Bishop score

Balloon Device

Inflated bulb of a Foley catheter exerts pressure to the internal os of the cervix which then stretches the lower uterine segment and stimulates release of prostaglandin (PG)

Contraindicated in patients with low-lying placenta

The catheter is left in place until it falls out spontaneously/24 hours have elapsed

Pharmacological approach

Artificial Rupture of Membrane

- one of the ways of induction of labor (IOL), usually to speed up the process of labor

- only been done when cervix is dilated to >4cm or > 3cm if indicated

- and baby's head firmly decended to the pelvis.

Contraindication:

1. Bishop score<6

2. breech

3. grandmultipara

4. preterm

5. high presenting head

6. polyhydramnious - if rupture is needed: need to have controlled ARM

    - where assistant is needed to control the baby's position to avoid baby from changing position

Risk: 

1. cord prolapse: if the baby head is not engaged well, and membrane rupture causing the cord to slip down below the baby's head.

2. Sepsis: when the labor time is prolonged

3. Failure of induction

4. increase risk of fetal distress

Before you start ARM procedure, always remember to check 

• Patient's name, and registration number
• confirm Antenatal history
• Are they indicated for ARM?
• or any contraindications
• check if any oligohydramnious / polyhydramnious - as baby could change position if not stabilised
• How is the position of the mother and Baby?
• Ensure there is an IV line set already with IV drip

• Vaginal Examination: any cord/ placenta
• Cx and Os dilation, Station
•  Ensure mother is not having contraction when you wanted to rupture the membrane
• only rupture when there is no contraction 
•  to avoid causing chorioamnionitis (acute inflammation of the membranes and chorion of the placenta, typically due to ascending polymicrobial bacterial infection in the setting of membrane rupture.)

    

Post ARM

• monitor mother's 
• vital sign
• contraction
• progress of labor 
• Vaginal examination 4hrly. 
• time contraction (NextReview of Contraction): 2hrly 
• baby's fetal heart rate

References: 

1. https://www.moh.gov.my/moh/resources/auto%20download%20images/587f135ba2e92.pdf