10 - Induction Of Labor

Question 1

Induction of labor:

Answer 1

Artificial initiation of labor prior to spontaneous onset

Question 2

Augmentation of labor:

Answer 2

Artificial speeding up of labor

Question 3

IOL maternal indications:

Answer 3

1– DM
2– Pre-eclampsia
3– Heart diseases

Question 4

IOL fetal indications:

Answer 4

1– Prolonged pregnancy
2– PROM
3– Chorioamnionitis
4– Placental insufficiency [Oligohydraminos or low fetal movements]
5– IUFD
6– antepartum hemorrhages 
7– Rh incompatibility
8– fetal anomalies

Question 5

IOL guidelines for DM mothers:

Answer 5

1– Controlled DM —> Not exceed 38 GW
2– Uncontrolled DM —> Up to 36 GW
3– Gestational controlled DM —> 41 GW + 1d
4– Gestational uncontrolled DM —> Up to 38 GW

Question 6

Pre-eclampsia maternal and fetal complications:

Answer 6

Maternal:
1– Hemorrhagic stroke
2– Seizure
3– HELLP syndrome

Fetal:
1– Low O2 and blood flow
2– Placental abruption and IUFD

Question 7

IOL indications in pre-eclampsia mothers:

Answer 7

If mild —> IOL

If severe —> CS

Question 8

IOL indications for heart diseased mothers:

Answer 8

Before mother develops HD symptoms such as pulmonary edema, SOB, cyanosis or palpitation

Question 9

MC indication for IOL:

Answer 9

Prolonged pregnancy

Question 10

IOL indications for PROM mothers:

Answer 10

1– If PROM after 37 GW —> Wait 24 hrs for spontaneous delivery, if not then IOL

2– If PROM before 37 GW: Either wait until 34 GW then do IOL or if the mother develops signs of infection then IOL is done immediately

Question 11

Chorioamnionitis complications on mother and fetus:

Answer 11

Mothers:
1– Edometritis 
2– Pelvic abscess
3– Intra-abdominal infection
4– Postpartum hemorrhage
5– Sepsis

Fetus: 
1– Still birth
2– Liver disease
3– Brain injury
4– Sepsis

Question 12

IOL indications in placental insufficiency mothers:

Answer 12

If doppler ultrasound is normal —> Up to 37 GW, if not then IOL

Question 13

IOL indications in antepartum hemorrhage mothers:

Answer 13

Right after excluding the other antepartum hemorrhage ddx [Like placenta previa and vasa previa]. So its done only for mothers with abrupt placenta

Question 14

IOL mother and fetal contraindications:

Answer 14

Mother; Anything that causes hemorrhage or anything that contraindicates the vaginal delivery in the first place:
1– Contracted pelvis [A reduced pelvis that interferes with labor]
2– Genital herpes infection
3– Pelvic surgery [For stress incontinence]
4– Uterine overdistention [Macrosomia, polyhydrominos, multiple pregnancies]
5– Grand multipara [5 or more births]
6– Placenta previa
7– Abnormal CTG
8– Transverse or oblique line
9– Breech presentation
10– 2 CS or more

Question 15

Bishop score:

Answer 15

Score out of 13 to determine the likelihood of successful IOL and includes:

1– Cervical dilatation [Closed, 1-2, 3-4, >5]
2– Cervical length [>2, 2-1, 1-.5,

Question 16

Changes for cervix to be ready for delivery:

Answer 16

1– Dilatation
2– Shortening and thinning
3– Softening [Ripening]
4– Change in position

Question 17

Requirements before IOL:

Answer 17

1– DVE for Bishop score
2– Cervical ripening 
3– Blood types and Abs screened
4– Continues CTG
5– Oxytocin and prostaglandin used

Question 18

IOL methods:

Answer 18

1– Prostaglandins
2– Oxytocin
3– Artificial rupture of membrane

Question 19

IOL method usage according to Bishop score:

Answer 19

<7 —> Unfavorable cervix —> Prostaglandin+AROM+ +/-Oxytocin

> 7 —> Favorable cervix —> AROM+ +/- oxytocin

Question 20

Cervical mechanical ripening methods:

Answer 20

1– Foley’s catheter [Between amnion and intrauterine wall and infusing 50 mL saline —> endogenous prostaglandins get released —> Normal labor happen]
2– Cook’s cervical ripening balloon

Question 21

Pharmacological methods of cervical ripening:

Answer 21

1– Prostaglandin

2– Oxytocin

Question 22

Prostaglandin MOA, types and uses:

Answer 22

1– Relax the cervical smooth muscle to promote dilation

2– E1 [Misoprestol and Cytotec] or E2 [Prostin]

3– Mother should be afebrile with normal CTG and no bleeding

Question 23

When to stop prostaglandin:

Answer 23

1– If Bishop is >=7 —> Do AROM
If effective uterine contractions arent obtained then start oxytocin

2– If Bishop is still <7 —> Repeat Prostaglandin next morning

Question 24

Ferguson reflex:

Answer 24

When AROM is done and the brain releases oxytocin

Question 25

Oxytocin doses:

Answer 25

Start by 2 mU/min and double the does every 30 minutes, and never exceed 32 mU/min in multipara and 64 mU/min in primigravida.
Reduce the dose after the uterine contractions are established

Question 26

Oxytocin should be maintained after delivery and until 3rd labor stage:

Answer 26

To prevent postpartum hemorrhage

Question 27

CC for IOL:

Answer 27

1– Prolonged labor
2– Prematurity
3– Failure of IOL
4– Postpartum hemorrhage [Because contracting smooth muscles will stop bleeding, so if the contractions were weak then bleeding will be more]

Question 28

CC for oxytocin:

Answer 28

1– Hyperstimulated uterus [Excess contractions in response to increase PGs]
2– Hypotension
3– Neonatal jaundice
4– Water intoxication [Coma, convulsions nad death because it’s similar to ADH]

Question 29

Uterine hyperstimulation #CC and its management:

Answer 29

— Can lead to fetal distress due to ischemia or uterine rupture

— Stop oxytocin, patient on her side, and give TERBUTALINE if it persists. [If it’s still persistent then do CS]

Question 30

Post-date VS post term pregnancy [AKA Prolonged pregnancy]:

Answer 30

— Beyond 40 weeks

— Beyond 42 weeks

Question 31

Prolonged pregnancy:

Answer 31

No cause [Physiological continuation] or anencephaly, fetal adrenal hypoplasia or PLACENTAL SULPHATASE ENZYME deficiency

Question 32

CC with prolonged pregnancy:

Answer 32

1– Meconium aspiration [Because PNS is mature, it can cause meconium passage]
2– Oligohydraminos and cord compression
3– Increased fetal weight —> Shoulder dystocia —> CS more likely

Question 33

عفت طيزي عصفحة ١٧

Answer 33

بكفي