Guidelines for induction

GUIDELINES for INDUCTION MODIFIED BISHOP SCORE INDUCTION ETIQUETTE WHAT ARE THE REVISED GUIDELINES CYTOTEC PHARMACOKINETICS ACTIVE MANAGEMENT INPATIENT vs OUTPATIENT HOW TO USE A FOLEY BULB CERVIDIL NOT RECOMMENDED

MODIFIED BISHOP SCORE ONLY 3 VARIABLES Positive Predictive Value for Delivery Equals or Exceeds Original 5 variable Bishop Score CERVICAL DILATION IS THE STRONGEST PREDICTOR AND CARRIES DOUBLE WEIGHT Obstet Gynecol 1982;60:137

MODIFIED BISHOP SCORE BEST PPV FOR DELIVERY ,[object Object],[object Object],[object Object],[object Object]

DILATION SCORE 0 0 cm 2 1-2 cm 4 3-4 cm 6 >4 cm CERVICAL LENGTH SCORE By digital PALPATION 0 3 cm 1 2 cm 2 1 cm 3 0 cm STATION SCORE In relation to spines 0 -3 1 -2 2 -1/O 3 + 1/+2

Favorable Cervix is score of 6 For Nulliparous cervix should also be 3-4 cm for Pitocin Induction ,[object Object],[object Object],Am J Obstet Gynecol 2003 Jun;188(6):1565-9

“ POP & PIT “ Amniotomy as Soon As Possible ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Arch Gynecol Obstet. 2009 Jun;279(6):813-20 Cochrane Database Syst Rev. 2009

DO NOT USE CYTOTEC WITH A FAVORABLE CERVIX ,[object Object],[object Object], Am J Obstet Gynecol 2004 Jun;190(6):1689-94

INDUCTION ETIQUETTE ,[object Object],[object Object],[object Object]

INPATIENT INDUCTION Etiquette & Wisdom ,[object Object],[object Object],[object Object],[object Object]

What are the Changes ARRIVE EARLIER ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What are the Changes ACTIVELY MANAGE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Cochrane Database Syst Rev. 2009 Cochrane Database Syst Rev 2001;(2): Am J Obstet Gynecol 2003 Oct;189(4):1031-5

INPATIENT PITOCIN INDUCTION Favorable Cervix ,[object Object],[object Object],[object Object],[object Object]

INPATIENT PITOCIN INDUCTION Favorable Cervix ,[object Object],[object Object],[object Object]

INPATIENT INDUCTION NOT a Favorable Cervix ,[object Object],[object Object],[object Object],[object Object]

INDICATIONS for OUTPATIENT CYTOTEC INDUCTION ,[object Object],[object Object],[object Object]

INDICATIONS for INPATIENT INDUCTION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Indications for a CST Prior to Induction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RIVERSIDE OUTPATIENT CYTOTEC GUIDELINES ,[object Object],[object Object],[object Object],[object Object],[object Object]

RIVERSIDE CYTOTEC GUIDELINES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RIVERSIDE OP CYTOTEC GUIDELINES 2nd dose of Cytotec ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RIVERSIDE OP CYTOTEC GUIDELINES 2nd dose of Cytotec ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RIVERSIDE OP CYTOTEC GUIDELINES ,[object Object],[object Object],[object Object],[object Object]

Why a Foley Bulb Induction As Effective as Cytotec and Probably safer ,[object Object],[object Object],[object Object],[object Object]

HOW TO PLACE a FOLEY BULB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Cochrane Database Syst Rev 2001 ,[object Object],Obstet Gynecol 2010;115:1239

Foley Bulb Placement Commits the patient to Delivery ,[object Object],[object Object],[object Object]

CERVIDIL NO SAFER THAN CYTOTEC AND LESS EFFECTIVE ,[object Object],[object Object],[object Object],[object Object],Am J Obstet Gynecol. 2010 Jun;202(6):624.e1-9 BJOG. 2008 Oct;115(11):1443-50.

CERVIDIL INCREASED RISK OF FAILED INDUCTION VS CYTOTEC ,[object Object],[object Object],[object Object],Cochrane Database Syst Rev 2003

CERVIDIL IS EXPENSIVE WITH NO VALIDATED SAFETY ADVANTAGE AND DEMONSTRATED INCREASED RISK FOR FAILED INDUCTION VS CYTOTEC ,[object Object],[object Object],[object Object],[object Object],[object Object],Cochrane Database Syst Rev 2003 BJOG. 2008 Oct;115(11):1443-50

Do the Math Think About In Patient Cytotec Night Start @ 41w4d ,[object Object],[object Object],[object Object]

Do the Math ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Guidelines for induction

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Guidelines for induction