8.) Labour induction and augmentation

Question 1

What is labour induction ?

Answer 1

Labour indcution is aimed at stimulating uterine contractions before spontaneous labour begins.

Question 2

What is labour augmentation ?

Answer 2

Labour augmentation refers to interventions used to stimulate uterine contractions that are already present but found to be inadequate.

Question 3

What are the indications for induction of labour ?

Answer 3

• Prolonged pregnancy >42 weeks.
• Premature rupture of the membranes
• Maternal issues : Hypertension , preeclampsia , diabetes , obstetric cholestasis , adruptio placenta , chorioamnionitis
• Fetal issues : Growth restriciton , fetal death , fetal anomaly , Rh incompatability.

Question 4

What are the contraindications for labour induction ?

Answer 4

• Pelvic tumour
• Malpresentation ( Breach , transverse lie)
• Previous C section ( increases risk of uterine rupture if labour is induced)
• Heart diseases
• Active herpes infection ( vaginal delivery can transmit it to the baby so C section is preferred
• Placenta previa ( placenta covers cervix)
• Vasa Previa ( Fetal blood vessels cross or run near the internal opening of the cervix)
• Unexplained vaginal delivery
• Triplets or more.

Question 5

What are the two components for cervical ripening ?

Answer 5

1.) Cervical softening ( dilation and effacement too)
2.) Uterine contraction.

Question 6

Draw the graph for bishops score ?

Answer 6

Favourable 6-13
Unfavourable 0-5

Question 7

What are the two main methods for cervical ripening ?

Answer 7

1.) Pharmacological
2.) Non-pharmacological

Question 8

Explain the pharmacological methods for cervical ripening ?

Answer 8

• Oxytocin infusion example diluted in iV infusion NACL initially start 4 drops/min for 15 mins.
• Prostaglandins : Misoprostol 25ug micrograms transvaginally every 3 hours max 4 doses or 50ug orally every 4 hours , this is contraindicated in women who had a c-section due to increase risk of uterine rupture.

Question 9

Explain the non pharmacological methods for cervical ripening ?

Answer 9

• Amniotomy (breaking the water) only if cervix is min 4cm
• Transcervical balloon catheter
• Mechanical dilators ( Hegar dilator)

Question 10

What is augmentation in terms of the baby and cervix ?

Answer 10

When the baby is going through the birth canal too fast and the cervix isn’t dilated enough but at min 4-6 cm

Augmentation is used to make weak or slow labor stronger by increasing contractions, helping the cervix open up and the baby move down for delivery. Cervix must be min 4-6 cm

Question 11

Augmentation example of administration ?

Answer 11

1 ampule of 5units IV starting 4 drops/min can increase 4 drops every 15-20 mins

Question 12

What are the conditions for augmentation ?

Answer 12

Bishops score > 7 / no fetal distress / clear liquid indicates no meconium / vertex position
Cervix 4-6cm dilated