Which of the following is not an indication for IOL?
a) suspected macrosomia on u/s
b) gestational hypertension at 38 weeks
c) logistical problems (hx of precipitous delivery, distance from hospital)
d) gestational diabetes before 39 weeks
a
If patient chooses to delay IOL until after 41 weeks, what should you order?
Twice weekly assessment of fetal well-being (NST or BPP)
What is the preferred method for cervical ripening in a patient attempting a TOLAC?
foley (PGE contraindicated given higher risk of rupture)
What is the definition of tachysystole?
More than 5 contractions per 10 minutes averaged over a 30 minute time period (can be with or without FHR changes)
What are the high priority indications for IOL (6)?
1) Pre-eclampsia > 37 weeks
2) Term Prom GBS+
3) maternal disease not responding to tx
4) chorioamnionitis
5) suspected fetal compromise
6) significant but stable antepartum hemorrhage
What are the lower priority indications for IOL (10)?
- post dates (>41 weeks) or post-term (>42)
- uncomplicated twin pregnancy > 38 weeks
- alloimmune disease at or near term
- gestational HTN > 38 weeks
- IUGR
- oligohydramnios
- diabetes mellitus (before 39)
- IUFD
- PROM at or near term GBS+
- IUFD in prior pregnancy
- logistical (distance from hospital, hx precipitous deliveries)
Name 8 contraindications to IOL
- placenta or vasa previa or cord presentation
- abnormal fetal lie or presentation
- prior classical or inverted t incision
- significant prior uterine sx (full thickness myomectomy)
- active genital herpes
- pelvic structural deformaties
- invasive cervical carcinoma
- previous uterine rupture
IOL may be associated with increased risk of:
- failure to achieve labour
- C/S
- operative vaginal delivery
- tachysystole with or without FHR changes
- chorio
- cord prolapse with ARM
- inadvertent delivery of preterm infant if inadequate dating
- uterine rupture in scarred or unscarred uteri
What factors have been shown to influence success rate of induction?
- Bishop score
- parity
- BMI
- maternal age
- EFW
- Diabetes
Postdates induction is the most common indication. It has been shown to decrease two important outcomes:
1) rate of meconium aspiration syndrome
2) rate of perinatal mortality
Studies have shown no increase rate of CS in IOL group and may in fact have a lower rate of CS
Name contraindications to foley cervical ripening
Absolute: low-lying placenta
Relative: APH, rupture of membranes, evidence of lower genital tract infection
What is the mechanism of action of PGE2?
acts on cervix by dissolving the collagen structural network of the cervix
When can you start oxytocin after ripening agent (for cervidil, miso, and gel)?
cervidil - 2 hours
miso - 4 hours
gel - 6 hours
When should women > 40 years of age be induced?
increased risk of stillbirth in older women . Due to this, experts suggest women >40 should be considered biologically post term at 39 weeks
