Originally Posted by wannabe  High chance that oxytocin will follow (if progress not adequate within 2 hours, which it rarely is if done as soon as woman is ARMable, rather than when VERY favourable). If oxytocin then drip & CTG tethering (reduced mobility), more pain -> epidural likely, if epidural then further tethering with IV fluids (to avoid hypotension) and BP cuff, even if 'mobile epidural' used. |
Limited research, but see Cochrane review
http://mrw.interscience.wiley.com/co...862/frame.html
in particular: "One trial compared amniotomy alone with a single dose of vaginal prostaglandins for women with a favourable cervix, and found a significant increase in the need for oxytocin augmentation in the amniotomy alone group (44% versus 15%; relative risk 2.85, 95% confidence interval 1.82 to 4.46). This should be viewed with caution as this was the result of a single-centre trial [however, it is the only trial data available]. Furthermore, secondary intervention occurred four hours after amniotomy, and this time interval may not have been appropriate."
Many units, reassess < 4 hours after amniotomy, so if 4 hourinterval is not appropriate (leading to increase in need for oxytocin augmentation), a shorter time interval would logically lead to even more oxytocin augmentation.
Risk of infection, and time limits introduced to prevent this.
Risk of cord prolapse if pp not engaged. |
Both these are quoted as risks in the opening post, and "common knowledge" - I'm sure in Mayes, Myles or any number of other standard textbooks. Plus risks associated with vasa praevia (placenta praevia has presumably been ruled out before you commence any form of induction).
If slow progress due to position rather than strength of uterine contractions, then ARM may exacerbate the problem rather than solve it. |
This is not really relevant to ARM induction, but only to ARM augmentation. It's based on ideas from Jean Sutton, theoretical rather than research based - but yes, not strictly revelevant to ARM induction.