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OB GYN RESIDENCY > Chapter 26: Induction & Augmentation Of Labor > Flashcards

Chapter 26: Induction & Augmentation Of Labor Flashcards

1
Q

Refers to the stimulation of contractions before spontaneous onset of labor, with or without ruptured membranes

A

Induction

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2
Q

Refers to the enhancement of spontaneous contractions that are considered inadequate because of failed cervical dilation and fetal descent

A

Augmentation

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3
Q

Enumerate indications for labor induction

A

Membrane rupture without contractions

Gestational hypertension

Oligohydramnios

Postterm pregnancy

Chronic hypertension Diabetes

*NRFS

William’s 25th Ed, page 503

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4
Q

At what AOG do we induce a patient with:

A. chronic hypertension?

B. Chronic hypertension without severe features?

C. Chronic hypertension with severe features?

A

CH: 38 weeks

CH with SPE without SF: 37 weeks

CH with SPE with SF: 34 weeks

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5
Q

At what AOG do we induce a patient with:

A. Pre-eclampsia with severe features?

B. Pre-eclamspia without severe features?

A

PE without SF: 37 weeks

PE with SF: 34 weeks

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6
Q

At what AOG do we induce a patient with:

A. Gestational hypertension, controlled

B. Gestational hypertension, uncontrolled

A

GH, controlled: 37 weeks

GH, uncontrolled: 34 weeks

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7
Q

At what AOG do we induce a patient with

A. Gestational DM, diet-controlled

B. Gestational DM, insulin-requiring

C. Overt DM

A

GDM-DC

  • POGS: 40weeks
  • ACOG: 39-40 weeks

GDM-IR

  • POGS: 37 weeks
  • ACOG: 37-38 weeks

Pre-existing DM

  • POGS: 37 weeks
  • ACOG
    • no vascular complications: 39 weeks
    • with vascular complications: 36-38 weeks
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8
Q

At what AOG do we induce a patient with uncomplicated pregnancy?

A

41 weeks

ARRIVE TRIAL: 39 weeks

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9
Q

Enumerate MATERNAL contraindications to labor induction.

A

Contracted/distorted pelvis

Prior uterine incision type

Abnormal placentation

Active genital herpes

Cervical cancer

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10
Q

Enumerate FETAL contraindications to labor induction.

A

Macrosomia

Severe hydrocephalus

Malpresentation

NRFS

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11
Q

All of the following are maternal complications associated with maternal induction/augmentation except:

A. Cesarean delivery

B. Chorioamnionitis

C. Uterine rupture

D. Postpartum hemorrhage

E. NOTA

A

E. NOTA

Additional info:

  • CS delivery is lower for women induced at 39 weeks.
  • Uterine rupture is 3x higher when oxytocin is given to a scarred uterus.
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12
Q

A 25-year old G3P2 (2002) presented at the OBAS with ruptured bag of waters at 38weeks AOG. Her BMI is 32kg/m2. Fundic height is at 30cm, estimated fetal weight is 3.0-3.2kg. On internal exam, cervix is soft, 1cm dilated, station -5, cephalic.

Which of the following is an unfavorable factor for induction success?

A. Maternal age

B. Parity

C. BMI

D. EFW

A

C. BMI

Favorable factors:

Younger age

Multiparity

BMI <30

Favorable cervix

EFW < 3500grams

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13
Q

True or false.

Greater CS delivery risk associated with induction is like strongly influenced by the induction attempt duration.

A

True.

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14
Q

Bishop Score criteria.

A

Dilatation

Effacement

Station

Consistency

Position

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15
Q

Enumerate.

The simplified Bishop score includes which cervical factors? (3)

A

Dilation

Effacement

Station

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16
Q

Misoprostol has FDA approval for use in what condition?

A. Menorrhagia

B. Medical abortion

C. Labor augmentation

D. Peptic ulcer prevention

E. Intractable vomiting

A

D. Peptic ulcer prevention

17
Q

This is the only biophysical marker that has been evaluated a Bishop score alternative.

A

Cervical length via TV-UTZ.

18
Q

Dinoprostone is not available in which of the following formulations?

A. Gel

B. Vaginal suppository

C. Impregnated intracervical balloon

D. Timed-release vaginal insert

A

C. Impregnated intracervical balloon

19
Q

Differentiate dinoprostone gel and vaginal insert administration in terms of:

A. Number of hours the patient should be reclined

B. Number of hours until oxytocin may be given

A

Gel:

Supine for 30mins

Oxytocin after 6-12 hours

Vaginal insert:

Supine for at least 2 hrs

Oxytocin 30mins after removal (insert is removed after 12 hours)

20
Q

Which is FALSE regarding dinoprostone gel?

A. Irrigation to remove gel preparation has been shown to be helpful.

B. Doses are repeated every 6 hours

C. Maximum of 3 doses in 24 hours

D. Gel is deposited just below the internal cervical os.

A

A. Irrigation to remove gel preparation has been shown to be helpful.

21
Q

The 20mg vaginal suppository form of dinoprostone is used in the following EXCEPT:

A. Pregnancy termination at 12-20weeks

B. Pre-induction cervical ripening

C. Evacuation of IUFD up to 28 weeks

D. NOTA

A

B. Pre-induction cervical ripening

Only the gel and insert forms are for cervical ripening.

22
Q

Which of the following is a CONTRAINDICATION to dinoprostone use?

A. Glaucoma

B. 6 or more term pregnancies

C. Asthma

D. RBOW

A

B. 6 or more term pregnancies

Use with caution:

  • Glaucoma
  • Asthma
  • RBOW

Contraindications:

  • Hypersensitivity
  • Fetal compromise
  • CPD
  • Unexplained bleeding
  • Women already receiving oxytocin
  • 6 or more term pregnancies
  • Previous CS or uterine surgery
23
Q

True or false.

Misoprostol is superior than PGE2 when it comes to labor induction.

A

True.

Misoprostol is supperior/equal to PGE2.

24
Q

True or false.

Nitric oxide donors are clinically more effective than prostaglandins.

A

False.

25
Q

True or false.

Risk for chorioamnionitis is greater when extraamnionic saline infusion via transcervical catheter is done.

A

False.

Extraamnionic saline infusion (EASI) is constant saline infusion through the catheter into the space between the internal os and placental membranes.

26
Q

These mechanical dilators draw water water from surrounding tissues and expand to geadually filate the cervical os.

A

Hygroscopic or osmotic dilators (eg. laminaria, Dilapan-S)

Additional info from chapter 15:

Shallow insertion: insufficient dilation

Deep insertion: dislodgment into the uterine cavity

27
Q

Low dose of oxytocin is at _____ mU/min.

High dose is at _____ mU/min.

A

Low: 0.5-2 mU/min

High: 4-6mU/min

28
Q

True or false.

Maximal effective dose of oxytocin to achieve adequate contractions in all women is different.

A

True.

29
Q

At 20mU/min infusion of oxytocin, women are likely to have:

A. Diarrhea

B. Poor urine output

C. Tachycardia

A

B. Poor urine output

Oxytocin is homologous to arginine vasopressin and at 20mU/min, may have siginificant antidiuretic action which can lead to water intoxication.

Consider giving a more concentrated infusion rather than increasing the flow rate of a more dilute solution.

30
Q

Early amniotomy (done at 1-2cm) reduces labor duation by __ hours.

A

4 hours.

31
Q

Late amniotomy (at 5cm) accelerates spontaneous labor by ____ hours.

A

1-1.5 hours

32
Q

Enumeration.

Amniotomy, aka surgical induction, increases risk of:

A

Chorioamnionitis

Cord prolapse

Abruptio (rare)

33
Q

Failure of induction is defined as:

A
  • no cervical change even with oxytocin augmentation for 24 hours
  • no change for 18 hours even with ruptured bag of waters and adequate contractions

OB GYN RESIDENCY (17 decks)

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