9.3 Induction of Labour Flashcards
At how many weeks is induction of labour offered for term babies?
41 and 42 weeks
What situations warrant IOL for early labour (less than term)?
- prelabour rupture of membranes
- FGR
- pre-eclampsia
- obstetric cholestasis
- existing diabetes
- intrauterine death
What scoring system is used to decide whether to proceed with IOL?
the Bishop score
What 5 things are assessed in the Bishop score?
- fetal station 0-3
- cervical postion 0-2
- cervical dilatation 0-3
- cervical effacement 0-3
- cervical consistency 0-2
What Bishops predicts a successful IOL?
8 or more suggests successful IOL
less suggests cervical ripening may be required
What are the options for IOL?
Membrane sweep (not a true method, more assistance)
Vaginal prostaglandin E2 (dinoprostone)
Cervical ripening ballons (CRB)
Artificial rupture of membranes (with oxytocin infusion)
Mifepristone (anti-progesterone) plus misoprostol for IUD
How long should a successful membrane sweep take to work?
Should produce onset of labour within 48 hours
involves finger into cervix and around membranes
What vaginal prostaglandin E2 (dinoprostone) options called?
Prostin (gel or tablet)
Propess (24 hr pessary)
What can vaginal prostaglandin E2 (dinoprostone) cause?
Prostin or Propess could cause uterine hyperstimulation.
What is non-pharmacologic and can be used instead of Propess / Prostin?
Cervical Ripening Balloon (CRB)
- silicone balloon inflated in cervix to dilate
What are the indications for a CRB over vaginal prostaglandins?
- previous c-section
- multiparous 3 or more
- vaginal prostaglandins have failed
What do you use to monitor the situation during an induction of labour?
- CTG (fetal HR and contractions)
- Bishops score to monitor progress
Most women give birth within 24hrs of IOL, what options do you have if progress is slow?
- further vaginal prostaglandins
- ARM and oxytocin infusion
- CRB
- elective c-section
Generally what are the criteria for uterine hyper stimulation?
- contractions longer than 2 mins
- more than 5 contractions in 10 mins
What can uterine hyper stimulation lead to?
- fetal hypoxia / acidosis
- emergency c-section
- uterine rupture
