Induction or stimulation of labour can be obtained with oxytocin infusion. Women should labour in a lateral decubitus position to attenuate hemodynamic fluctuations associated with major contractions in the supine position. Care must be exercised with regard to volume status. The anesthetic of choice is lumbar epidural. The fetus should pass through the pelvis in response to the force of uterine contractions, unaugmented as much as possible with straining.
Delivery is assisted by vacuum extraction and low forceps.
Following delivery, careful monitoring needs to be maintained for up to 72 hours, occasionally in an intensive care unit environment. Routine pediatric cardiac assessment of the newborn infant is advised. In adolescents, they may cause depression. Progesterone only pills have a higher failure rate than combined oral contraceptive pills but can be considered. Intra uterine devices may increase the risk of endocarditis and, particularly in cyanotic women, cause increased bleeding.