Transcript بخش 1 : برنامه ریزی استراتژی

Cook Cervical Ripening Balloon
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Product information
18Fr, 40 cm
Dual 80 ml balloons
100% Silicone
Box of 10
J – CRB – 184000 or G48149
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Advantages of this balloon over other methods include
• It is particularly successful in women with
unfavourable cervices
• It is non pharmacological, so does not cause
hyperstimulation
• It is relatively easy to insert
• Reduces the need for multiple vaginal examinations
• Reduced the need for continuous monitoring
• Increases the chances of vaginal delivery by
producing a primed dilated cervix for ARM
• Can be used for women with IUD 3rd trimester IUDS
reducing the need for multiple vaginal examinations
Disadvantages
• May require a doctor to insert in
lithotomy position
• Catheter remains for 12 – 24 hours
which may be unacceptable to women
Contra – indications
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Patients receiving or planning to undergo exogenous prostaglandins
Placenta previa / vasa previa or placenta accerta
Transverse lie / breech / head above the pelvic brim
Ruptured membranes
Severe maternal / fetal compromise ( e.g. PET requiring urgent delivery )
Multiple gestation
Polyhydramnios
Abnormal fetal heart rate changes
Any contraindication to induction of labour
Active genital herpes
Invasive cervical cancer
Pelvic structural abnormality
Previous hysterotomy / uterine perforation / myomectomy traversing the
myometrium
Cautions
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Must not be left for more than 24 hours
Must be used with care in women with previous caesarean section
If fetal membranes rupture whilst the CCRB is in situ then it must be removed
and plan of management discussed with the consultant on call
Must not be used in women who have recently been given prostaglandins
( < 12 hours ) as this accentuates the adverse events associated with their use
Hyperstimulation
Impaired utero – placental circulation
Tachysystole
Uterine rupture
Amniotic fluid embolism
Pelvic pain
Retained placenta
Genital bleeding shock
Bradycardia
Setting up for cooks cervical ripening balloon insertion
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Equipment
Syringes 60ml ×4
Needle 16 gauge needle
Vaginal pack
Sponge holder × 1
Normal saline bags 100ml ×2
Cook cervical ripening balloon
Disposable speculum
Water / aqueous savlon solution to clean
Patient preparation
1- the patient is brought to labour ward
2- once a normal CTG is obtained the doctor is informed to
insert the balloon
3-confirm presentation / placental localization with abdominal
ultrasound
4- place the patient on the left lateral position / lithotomy position
5-Insert large vaginal speculum to gain cervical access
6- Clean the cervix with the appropriate cleaning solution to
prepare for device insertion
Device insertion
• Insert the device and advance both balloon into the cervical
canal
• Inflate the internal balloon with 40ml of normal saline through
the check flow valve u ( red)
• Once inflated pull back until balloon rests against the internal os
• The vaginal balloon is now inflated to 40ml through check flow
valve v (green)
• Once on either side of the cervix and device the speculum is
removed
• Add more fluid into each balloon until both balloons are filled to
80mls each
• Do not over inflate the balloon
• Taped to patients leg
• Remove after 12-24 hours
Procedure for removal of the balloon and after
• 12- 24hours later the balloon is removed , this is
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done by removing fluid from both balloon .
The patient dose not need to be placed in lithotomy for this .
Once the balloon is removed, an ARM should be done soon
after.
If not contracting within one hour, then an oxytocin infusion
should be commenced.
In the event that the head is high ARM should be avoided
until the head is lower in the pelvis .
Consideration for commencement syntocinon with intact
membranes
• PGE
, Oxytocin , Ripening Balloon
• Results
• Balloon and PGE2 Were comparable
- Change in Bishop score – 5
- Interval to delivery - 20 hours
- Cesarean Rate
• Both methods were superior to oxytocin
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• PGE 2 , Oxytocin , Ripening Balloon
• Results
• Balloon was superior to both PGE2 & Oxytocin
- Cervical Dilation - > 3cm in > 90% of patients
- Failure Rate - < 10%
• Compared to over 20% for PGE 2 & 50% for
oxy