MDJ-Induction of labor - revised.pptx - Induction and...

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Induction and augmentation of labor protocol review MONIQUE DE FOUR JONES, M.D.OBSTETRICAL PATIENT SAFETY OFFICERNYU BROOKLYN HOSPITAL
Objective Discuss induction and augmentation agent currently available at NYU LutheranDiscuss addition of oral misoprostol as a cervical ripening agentDescribe titrated oral misoprostol protocol and evidence supporting its use
BackgroundPurpose: To achieve vaginal delivery by stimulating uterine contractions before the spontaneous onset of labor. Benefits must be weighed against the potential maternal and fetal risks associated with this procedure Elective inductions of labor should be avoided until 39weeks (40 weeks per NYU policy)ACOG PB #107
Indications for inductionPlacental abruption,ChorioamnionitisFetal demiseGestational hypertension, Pre-eclampsia, eclampsia, Premature rupture of membranesLate-term and post-term pregnancyMaternal medical conditions (such as diabetes mellitus, renal disease, chronic pulmonary disease or chronic hypertension)Fetal compromise (such as severe fetal growth restriction, oligohydramnios or isoimmunization)
Indications for augmentationCurrent definitions needs revision or clarificationProlonged latent phase (Friedman, 1963)> 20 hours in nullip; > 14 hours in multip;Arrest of active phase (Zhang, 2010)No cervical change at > 6cm dilated with membrane rupture for at least 4 hours with adequate contractions or at least 6 hours with inadequate contractions.Protracted labor (Zhang, 2010)Slower progress at >6cm dilatedProtracted descent, < 1 cm/hour in nullip, < 2 cm/hour in multip.Arrest of descent, > 3hrs in nullip or > 2 hrs multip
Cervical ripeningTo facilitate the process of cervical softening, thinning, and dilating to reduce the risk of failed induction and induction to delivery time.The status of the cervix can be determined by the Bishop scoring system Bishop score of 6 or less is considered unfavorable in most randomized trialsAgentsMisoprostol* DinoprostoneCervical FoleyOxytocinACOG PB#107
Methods of induction - MisoprostolSynthetic PGE1Can be administered vaginally, orally or sublinguallyOral administration my be in the form of tablet or titrated liquid

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