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Cephalopelvic Disproportion and Contracted Pelvis
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Artificial rupture of membranes (ARM) is an important intervention. It not only augments labour but also helps in the detection of caput, moulding and of course, the presence of meconium. However, a controlled ARM should be performed after regular uterine contraction has been established and a cervix is at least 3 cm dilated. Preventing cord prolapse when the head is above the brim is an important principle guiding the procedure. Too early, an ARM may not be prudent as it may compromise the time available for the trial, increase the risk of infection, reduce the cushioning effect to the fetal cord, and pose a cord prolapse threat.
Prelabor rupture of the membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Lami Yeo, Francesca Gotsch, Eleazar Soto, Sonia S. Hassan, Juan Pedro Kusanovic, Ray Bahado-Singh
Dombroski et al. reported a study in which amniotic fluid was obtained by amniocentesis in patients at term in labor (200). Thirty minutes after artificial rupture of membranes, a vaginal sample of amniotic fluid was collected. L/S ratios obtained from amniotic fluid in the vaginal pool samples were significantly lower than those obtained by amniocentesis. However, in 22% of cases, L/S ratios were higher in the vaginal pool samples than amniocentesis.
Treatment of pre-eclampsia
Published in Pankaj Desai, Pre-eclampsia, 2020
There are a few mechanical methods for inducing labour. This includes artificial rupture of membranes and stripping of membranes. Amongst all these, Foley catheter balloons are the most commonly used mechanical device for labour induction currently. It acts both as a mechanical dilator of the cervix as well as a stimulator of prostaglandins released from the foetal membranes. Compared with vaginal PGE2 gel in term labour induction, a Foley catheter achieved similar vaginal delivery rates, with fewer maternal and neonatal side effects.15 A Foley catheter left in place for up to 12 hours brings about cervical changes sufficient for term labour induction, and shorter ripening time is associated with earlier artificial rupture of the membranes and start of oxytocin augmentation, which might be related to quicker labour onset.16 In this, the cervix is visualised by a speculum examination, and the catheter is passed feeling that the balloon is between the amniotic sac and the lower uterine segment. The balloon is then inflated with about 30 mL of saline solution and left in place. For women with an unfavourable cervix at term, including those with pre-eclampsia, induction of labour with a Foley catheter is safe and effective. Higher balloon volume (80 mL vs 30 mL) and longer ripening time (24 hours vs 12 hours) would not shorten the induction to delivery interval or reduce caesarean section rate.16
Effectiveness of aromatherapy in reducing duration of labour: a systematic review
Published in Journal of Obstetrics and Gynaecology, 2022
Ashraf Ghiasi, Leila Bagheri, Fatemeh Sharaflari
Prolonged labour is associated with increased risk of infection, hypoxia and perinatal death, postpartum haemorrhage or infection (Talebi et al. 2020). A broad range of pharmacological and non-pharmacological methods are typically used for labour induction and augmentation (Hall et al. 2012). A variety of methods which include stripping of the membranes, artificial rupture of membranes and pharmacologic agents, such as (prostaglandins and oxytocin) are used for induction of labour (Levine et al. 2016). However, these methods are usually associated with side effects. Therefore, in recent years, the use of non-pharmacological methods of delivery management, such as touch, aromatherapy, acupuncture, acupressure, reflexology and exercise to reduce the length of labour have become particularly popular.
Foley catheter for induction of labour: a UK observational study
Published in Journal of Obstetrics and Gynaecology, 2020
Elizabeth Stephenson, Aditya Borakati, Ian Simpson, Padma Eedarapalli
Information was given to the women antenatally both verbally and in an information leaflet. Preinduction checks and assessments such as BS and CTG were assessed as per unit protocol. The Foley catheter balloon was inserted (by either doctors or midwives) into the cervix either under direct vision or by feel. A metal stylet was available for guiding insertion if necessary. The balloon was inflated to 50 mL with normal saline once above the internal os. The catheter was taped to the thigh with gentle traction in the first 50 cases but was left loose in the second half of the study group due to emerging evidence for no significant impact (ten Eikelder et al. 2016). Suitability for artificial rupture of membranes (ARM) was assessed after 24 h or expulsion of the catheter, whichever occurred earliest. Outpatients were readmitted at either endpoint.
Comparison of intracervical Foley catheter used alone or combined with a single dose of dinoprostone gel for cervical ripening: a randomised study
Published in Journal of Obstetrics and Gynaecology, 2019
Anqa Chowdhary, Rashmi Bagga, Vanita Jain, Subhas Chandra Saha, Praveen Kumar
Unless expelled earlier, the catheter was removed after 12 hours and the Bishop was assessed. Oxytocin was initiated (with infusion pump) at 3 mU/min. and escalated by similar increments every 30 minutes until regular contractions (3 in 10 minutes) established; until 42 mU/min. Further escalation (up to 72 mU/min.) was decided by consultant in charge. A partogram was maintained and the foetal heart was auscultated every 30 minutes in the first stage and every 15 minutes in the second stage by residents. In event of foetal heart or contraction abnormality, CTG was recorded. A pelvic examination was done every 4 to 6 hours. An artificial rupture of membranes (ARM) was done at the onset of regular contractions and when the cervical dilatation was >3 cm, if foetal head was fixed. A failed induction was the failure to generate regular contractions (3 in 10 minutes) and a cervical change after 24 hours of oxytocin, of which at least 12 hours were after membrane rupture (Spong et al. 2012). Non-progress of labour (NPL) was the absence of cervical change following latent phase (until 4 cm dilatation); after 4 hours of moderate contractions or after 6 hours if the contractions were not sustained (Rouse et al. 1999). In case of a foetal heart abnormality (rate >l60 or <110, loss of variability or decelerations) or contraction abnormality (tachysystole or ≥6 contractions in 10 minutes for 20 minutes, hypertonus or prolonged contraction >2 minutes and hyperstimulation: tachysystole or hypertonus plus foetal heart abnormality), the oxytocin was withheld, and the woman was given oxygen in left lateral recumbent position.