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Amniotomy

Amniotomy may be done early in labor unless spontaneous rupture has occurred or contraindications are present.

 

In nulliparous patients, early amniotomy is a component in the active management of labor protocol and has been shown to reduce the duration of labor [A], [M]

 

Contraindications for amniotomy include:

  1. Presentation unknown, floating, or unstable
  2. Cervix dilated less than 3 cm
  3. Patient refuses

The Bishop score

 

The Bishop score is used to assess women for the induction of labor with oxytocin with or without artificial rupture of the placental membranes.

 

Factor

Score

Dilatation (cm)

Effacement (%)

Station

Cervical Consistency

Cervical position

0

1

2

3

Closed

1-2

3-4

ï5

0-30

40-50

60-70

>80

-3

-2

-1

+1 to +2

Firm

Medium

Soft

-

Posterior

Mid-position

Anterior

 

 

A score of 9 conveys a high likelihood for a successful induction. Score of 4 or less identifies unfavorable cervix and needs for cervical ripening.

  1. Local application of prostaglandin E2 (dinoprostone) is commonly used for cervical ripening.
  2. ACOG has approved use of 25 μg vaginal misoprostol for cervical ripening.
  3. A vaginal dose of 50 μg is associated with tachysystole / meconium passage aspiration.





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