(8) Induction and Augmentation of Labor, Delivery

Induction of labor

Term for attempts to begin labor in nonlaboring patient

• Oxytocin

• Amniotomy

Methods for induction of labor

Augmentation of labor

Term for interventions to increase pre-existing contractions

Loveset maneuver

Maneuver for reduction of nuchal arms in breech delivery

Dührssen incision

· Incision on the cervix at 2 o'clock, and at 10 o'clock position (additional at 6 o'clock).
· Incisions are placed to minimize bleeding from the laterally located cervical branches of the uterine artery

Malposition

If occiput transverse (OT) or occiput posterior (OP) persists during internal rotation, it is called...?

Shoulder dystocia

Difficulty in delivering shoulders, due to impaction of anterior shoulder behind pubic symphysis

ALARMERS

• Ask for Assistance

• Lift the legs

• Anterior shoulder disimpaction

• Rotation

• Manual removal of posterior arm

• Episiotomy

• Roll-over into 4’s

• Supine

Mnemonic for the shoulder dystocia drill

Turtle sign

Term for incomplete delivery of the head or chin tucking up against the maternal perineum

McRoberts maneuver

Maneuver characterized by hyperflexion of maternal hips towards maternal abdomen →flattens lumbar spine and ventrally rotates maternal pelvis and symphysis→decrease pelvic inclination, increase AP diameter

Suprapubic pressure

Maneuver characterized by pressure above maternal pubic symphysis to dislodge anterior shoulder from behind pubic symphysis

Rubin maneuver

Maneuver characterized by pressure on either accessible shoulder toward anterior chest wall of fetus to decrease bisacromial diameter and free impacted shoulder

Wood corkscrew maneuver

Maneuver characterized by pressure behind posterior shoulder to rotate infant and free anterior shoulder

Cleidotomy

Intentional fracture of fetal clavicle

Symphysiotomy

Intentional cutting of pubic symphysis, used to deliver entrapped aftercoming head

Gaskin maneuver

Placement of patient on hands and knees

Zavanelli maneuver

Placing infant's head back into pelvis and performing cesarean delivery

Forceps delivery

· Higher rate of facial nerve palsy
· Higher rate of third- and fourth-degree lacerations
· Blades conforming to curves of maternal pelvis are placed around fetal head→user guides fetal head to proper descent

Vacuum delivery

· Higher rate of cephalohematomas, scalp lacerations, shoulder dystocia
· May lead to rare subgaleal hemorrhages

FORCEPS

• Fully dilated cervix

• Occiput/vertex presentation

• Ruptured membranes

• CPD not suspected

• Engaged head, experienced operator, emptied bladder

• Position known, painless (adequate anesthesia)

• Size (fetal weight) estimated

Mnemonic for forceps delivery

Approximately 3 cm in front of the posterior fontanel and approximately 6 cm from the anterior fontanel

In vacuum-assisted delivery, where is the flexion point to which the cup is placed?

Pfannenstiel

A CS incision wherein the skin incised in a transverse, slightly curvilinear manner 3cm above the border of the symphysis pubis

Maylard

A CS incision similar to Pfannenstiel, but the rectus abdominis muscle bellies are transected

Joel-Cohen

A CS incision wherein there is greater use of blunt dissection; a straight 10-cm transverse skin incision is made 3 cm below the ASIS

Misgav Ladach

A CS incision similar to Joel-Cohen, but instead the peritoneum is entered bluntly

Low transverse cesarean incision (Kerr)

The preferred and most common uterine incision; associated with less bleeding and risk of rupture; may be extended to a J-, U-, or T-incision

Low-vertical incision (Krönig)

This CS incision is confined to the lower uterine segment (LUS)

• Densely adhered bladder
• Leiomyoma occupies the LUS
• Cervical cancer
• Massive maternal obesity precluding safe access to the LUS
• Placenta previa with anterior implantation
• Back-down transverse lie presentation

Classical CS incision indications

Patients with a prior upper uterus incision

Highest rupture rate in vaginal birth after Cesarean section

Nonreassuring FHR pattern

Most common sign of uterine scar rupture