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TN Obstetrics > 11. Induction of Labour > Flashcards

11. Induction of Labour Flashcards

1
Q

Define: Induction of labour (1)

A

artificial initiation of labour in a pregnant woman prior to spontaneous initiation to deliver the fetus and placenta

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2
Q

Name Prerequisites for Labour Induction (3)

A
  • capability for C/S if necessary
  • maternal: inducible/ripe cervix: short, thin, soft, anterior cervix with open os
  • fetal:
    • normal fetal heart tracing
    • cephalic presentation
    • adequate fetal monitoring available
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3
Q

If cervix is not ripe for induction of labour, what to do? (4)

A
  • prostaglandin vaginal insert (Cervidil®)
  • prostaglandin gel (Prepidil®)
  • misoprostol (Cytotec®)
  • Foley catheter
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4
Q

Induction is indicated when? (1)

A

when the risk of continuing pregnancy exceeds the risks associated with induced labour and delivery

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5
Q

Likelihood of success of induction of labour determined by what? (3)

A

Bishop score

  • cervix considered unfavourable if <6
  • cervix favourable if ≥6
  • score of 9-13 associated with high likelihood of vaginal delivery
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6
Q

Name cervical characteristics in Bishop score (5)

A
  • Position
  • Consistency
  • Effacement (%)
  • Dilatation (cm)
  • Station of Fetal Head
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7
Q

Describe Bishop Score 0

  • Position
  • Consistency
  • Effacement (%)
  • Dilatation (cm)
  • Station of Fetal Head
A
  • Position: Posterior
  • Consistency: Firm
  • Effacement (%): 0-30
  • Dilatation (cm): 0
  • Station of Fetal Head: -3
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8
Q

Describe Bishop Score 1

  • Position
  • Consistency
  • Effacement (%)
  • Dilatation (cm)
  • Station of Fetal Head
A
  • Position: Mid
  • Consistency: Medium
  • Effacement (%): 40-50
  • Dilatation (cm): 1-2
  • Station of Fetal Head: -2
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9
Q

Describe Bishop Score 2

  • Position
  • Consistency
  • Effacement (%)
  • Dilatation (cm)
  • Station of Fetal Head
A
  • Position: Anterior
  • Consistency: Soft
  • Effacement (%): 60-70
  • Dilatation (cm): 3-4
  • Station of Fetal Head: -1,0
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10
Q

Describe Bishop Score 3

  • Position
  • Consistency
  • Effacement (%)
  • Dilatation (cm)
  • Station of Fetal Head
A
  • Position: -
  • Consistency: -
  • Effacement (%): _>_80
  • Dilatation (cm): _>_5
  • Station of Fetal Head: +1, +2, +3
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11
Q

Differentiate: Induction vs. Augmentation (2)

A
  • Induction is the artificial initiation of labour
  • Augmentation promotes contractions when spontaneous contractions are inadequate
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12
Q

Name indications of induction (4)

A
  • post-dates pregnancy (generally >41 wk) = most common reason for induction
  • maternal factors
  • maternal-fetal factors
  • fetal factors
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13
Q

Name MATERNAL indications of induction (5)

A
  • DM = second most common reason for induction
  • gestational HTN ≥37 wk
  • preeclampsia
  • other maternal medical problems, e.g. renal or lung disease, chronic hypertension, and cholestasis
  • maternal age over 40
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14
Q

Name MATERNAL-FETAL indications of induction (3)

A
  • isoimmunization
  • preterm premature rupture of membranes PROM
  • chorioamnionitis
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15
Q

Name FETAL indications of induction (3)

A
  • suspected fetal jeopardy as evidenced by biochemical or biophysical indications
  • macrosomia, fetal demise, intrauterine growth restriction IUGR, oligo/polyhydramnios, anomalies requiring surgical intervention, and twins
  • previous stillbirth or low pregnancy-associated plasma protein A (PAPP-A)
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16
Q

Name risks of induction (4)

A
  • failure to achieve labour and/or vaginal birth
  • uterine hyperstimulation with fetal compromise or uterine rupture
  • maternal side effects to medications
  • uterine atony and postpartum hemorrhage (PPH)
17
Q

Name maternal contraindications (5)

A
  • prior classical or inverted T-incision C/S or uterine surgery (e.g. myomectomy)
  • unstable maternal condition
  • active maternal genital herpes
  • invasive cervical carcinoma
  • pelvic structure deformities
18
Q

Name maternal-fetal contraindications (2)

A
  • placenta previa or vasa previa
  • cord presentation
19
Q

Name fetal contraindications (3)

A
  • fetal distress
  • malpresentation/abnormallie
  • preterm fetus without lung maturity
20
Q

Consider the Following Before Induction… (8)

A
  • Indication for induction
  • Contraindications
  • GA
  • Cervical favourability
  • Fetal presentation
  • Potential for CPD
  • Fetal well-being/FHR
  • Membrane status
21
Q

Describe: Cervical ripening (2)

A
  • use of medications or other means to soften, efface, and dilate the cervix; increases likelihood of successful induction
  • ripening of an unfavourable cervix (Bishop score <6) is warranted prior to induction of labour
22
Q

Name methods of cervical ripening (4)

A
  • intravaginal prostaglandin PGE2 gel (Prostin® gel): long and closed cervix
    • recommended dosing interval of prostaglandin gel is every 6-12 h up to 3 doses
  • intravaginal PGE2 (Cervidil®): long and closed cervix, may use if rupture of membranes ROM
    • continuous release, can be removed if needed
    • controlled release PGE2
  • intracervical PGE2 (Prepidil®)
  • intravaginal PGE1 misoprostol (Cytotec®): long and closed cervix
    • inexpensive, stored at room temperature
    • more effective than PGE2 for achieving vaginal delivery and less epidural use
  • Foley catheter placement to mechanically dilate the cervix
23
Q

Name theoretical advantages of Intravaginal PGE2 Cervidil® (4)

A
  • Slow, continuous release
  • Only one dose required
  • Ability to use oxytocin 30 min after removal vs. 6 hours for gel
  • Ability to remove insert if required (i.e. excessive uterine activity)
24
Q
A
25
Q

Describe: Amniotomy (3)

A
  • artificial ROM (amniotomy) to stimulate prostaglandin synthesis and secretion; may try this as initial measure if cervix is open and soft, the membranes can be felt, and if the head is present at the cervix
  • few studies address the value of amniotomy alone for induction of labour
  • amniotomy plus intravenous oxytocin: more women delivered vaginally at 24 h than amniotomy alone (relative risk = 0.03) and had fewer instrumental vaginal deliveries (relative risk = 5.5)
26
Q

Describe oxytocin for induction of labor (5)

A
  • oxytocin (Pitocin®): 10 U in 1L NS, run at 0.5-2 mU/min IV increasing by 1-2 mU/min q20-60min
  • reduces rate of unsuccessful vaginal deliveries within 24 h when used alone (8.3% vs. 54%, RR 0.16)
  • ideal dosing regimen of oxytocin is not known
  • current recommendations: use the minimum dose to achieve active labour and increase q30min as needed
  • reassessment should occur once a dose of 20 mU/min is reached
27
Q

Name potential complications of oxytocin in induction of labor

A
  • hyperstimulation/tetanic contraction (may cause fetal distress or uterine rupture)
  • uterine muscle fatigue, uterine atony (may result in postpartum hemorrhage PPH)
  • vasopressin-like action causing anti-diuresis

TN Obstetrics (16 decks)

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