KHUH

WHO

NICE

ACOG

SOGC

FOGSI

Queensland

Uterine Rupture

-Associated with PGE₂ and oxytocin use

NA

-If suspected, deliver through emergency CS

-Associated with use of misoprostol in women with previous CS or major uterine surgery

-Associated with:

· Aggressive use of uterotonic agents in obstructed labour

· Use of PGE₂ in VBAC

-Associated with multiparity, malpresentation, unsupervised or aggressive use of uterotonics

-Monitor maternal vital signs and FHR

-Associated with:

· Oxytocin

· Balloon catheter

-Deliver by emergency CS when suspected

Uterine Hyperstimulation

-Associated with use of oxytocin

-Use betamimetics

-Associated with PGE₂

-Remove vaginal PGE₂ pessary

-Associated with PGE₂ and misoprostol use

-Reduce/stop oxytocin infusion, turn patient to side

-CS or terbutaline if abnormal FHR

-Tocolytics:

· IV nitroglycerin 50mcg over 2-3 mins every 3-5 mins, max dose 200 mcg;

· Alternative: 1-2 puffs of nitroglycerin spray 0.4 mg sublingual

-Reduce/stop oxytocin infusion

-If FHR remains abnormal, instrumental birth or CS

-Use tocolytics if no cardiac disease.

-Turn mother to left lateral position and monitor vital signs.

-Tocolytics:

· Terbutaline: 250 mcg SC or 5 ml IV over 5 mins

· Salbutamol 100 mcg slow IV inj

· Sublingual GTN spray 400 mcg

-Consider the use of tocolytics if persisting

Failed Induction

Options:

-Allow patient to rest

-Reassess then restart IOL

-IOL with oxytocin

-Deliver via CS

NA

-Discuss with patient considering her circumstances and provide support

-Consider CS

NA

-Re-evaluate indication and method of induction

-Differentiate between failed IOL and failure to progress

-Review individual case

-Discuss options

-Consider delivery via CS or operative vaginal delivery

NA

-Consider another attempt at IOL with different method

Amniotomy

To reduce risk of cord prolapse

· Before ARM: Perform VE to exclude cord presentation and determine fetal head station

· After ARM: Perform VE to ensure no cord prolapse

-Risks: vaginal bleeding, discomfort

To reduce risk of cord prolapse

-Palpate for umbilical cord presentation during VE and avoid dislodging baby’s head

To reduce risk of cord prolapse

-Caution when performing ARM in unengaged presentation and do not remove finger from vagina until presenting part rests against cervix

-Assess engagement of presenting part before ARM

-Avoid amniotomy if head high

-Palpate for umbilical cord presentation during VE and avoid dislodging baby’s head

-Assess engagement of presenting part before ARM

-Avoid amniotomy if head high

-Risks: chorioamnionitis, umbilical cord compression or rupture vasa previa, displacement of presenting part

Abbreviations: NA: not applicable; PGE₂: prostaglandin E₂; CS: Cesarean section; VBAC: vaginal birth after Cesarean; FHR: fetal heart rate; IV: intravenous; IOL: induction of labour; VE: vaginal examination; ARM: artificial rupture of membranes