Managing Complications in Pregnancy and Childbirth: - IAWG

P-18 Induction and augmentation of labour• Place two fingers against the membranes and gently rupture themembranes with the instrument in the other hand. Allow theamniotic fluid to drain slowly around the fingers.• Note the colour of the fluid (clear, greenish, bloody). If thickmeconium is present, suspect fetal distress (page S-95).• After ARM, listen to the fetal heart rate during and after acontraction. If the fetal heart rate is abnormal (less than 100 ormore than 180 beats per minute), suspect fetal distress (page S-95).• If delivery is not anticipated within 18 hours, give prophylacticantibiotics in order to help reduce Group B streptococcus infectionin the neonate (page C-35):- penicillin G 2 million units IV;- OR ampicillin 2 g IV, every 6 hours until delivery;- If there are no signs of infection after delivery, discontinueantibiotics.• If good labour is not established 1 hour after ARM, begin oxytocininfusion (page P-19).• If labour is induced because of severe maternal disease (e.g. sepsisor eclampsia), begin oxytocin infusion at the same time as ARM.INDUCTION OF LABOURASSESSMENT OF THE CERVIXThe success of induction of labour is related to the condition of thecervix at the start of induction. To assess the condition of the cervix, acervical exam is performed and a score is assigned based on the criteriain Table P-6:• If the cervix is favourable (has a score of 6 or more), labour isusually successfully induced with oxytocin alone.• If the cervix is unfavourable (has a score of 5 or less), ripen thecervix using prostaglandins (page P-24) or a Foley catheter (pageP-25) before induction.