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Induction of Labor

Induction of Labor. Joseph Breuner, MD Obstetrics Fellowship Director Swedish Family Medicine Residency April 10, 2007. Why is induction important?. 40 to 60 % of pts at first hill get pitocin Labor is terrifying Transition from passive to active medical role. Teaching points.

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Induction of Labor

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  1. Induction of Labor Joseph Breuner, MD Obstetrics Fellowship Director Swedish Family Medicine Residency April 10, 2007

  2. Why is induction important? • 40 to 60 % of pts at first hill get pitocin • Labor is terrifying • Transition from passive to active medical role

  3. Teaching points • Stillbirth rate • Foley bulb • Doubles c-section rate for any indication

  4. Stillbirth • Devastating event • Defined as death before delivery after 20 wks • Collective incidence 6 per 1000 • Fear of this motivates ob decisions, often irrationally Silver, ob/gyn 2007

  5. Stillbirth by gestational age Gabbe 2002

  6. ACOG recommends • Consider induction in pts >41 wks with a favorable cervix • If cx unfavorable, semiweekly testing or induction are ‘equally reasonable options’ Gabbe 2002

  7. dating • 1. 1st tri scan • 2. 2nd tri scan • 3. good LMP • 4. 3rd tri scan

  8. When do I get NST/AFI? • NST at 41 and 41 3 or 4/7 • AFI at 41 • Induce at 42 Joe, today

  9. Never Induce Before • 39 wks without • Amnio for fetal lung maturity • Strong medical indication • both

  10. Mechanical induction methods • Foley bulb

  11. Induction doubles section rate • First hill and ballard campuses • 1999 and 2000 • Luthy et al

  12. Teaching points • Stillbirth rate 1 per 1000, 1.5, 1.8, 2.9 at 40, 41, 42, 43 wks • Foley bulb • Induction doubles section rate

  13. Case 1 • 28 yr old primip at 40 1/7 wks • Prodroming for 4d, in triage every 12 hours • “why can’t you induce my labor?”

  14. Case 1 • Cervix bishop score 3 • Nst ok • Afi fluid ok

  15. Case 2 • Multip 35 yrs old somali woman • 42 3/7 • Only 2 pn visits in last month • Now in yr exam room • No antenatal testing • God will take care of me

  16. Case 3 • 41 3/7 wk primip • Bishop score 2 • NST non reactive with variable to 80’s • AFI 10

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