Chapter 26: Induction & Augmentation Of Labor Flashcards
Refers to the stimulation of contractions before spontaneous onset of labor, with or without ruptured membranes
Induction
Refers to the enhancement of spontaneous contractions that are considered inadequate because of failed cervical dilation and fetal descent
Augmentation
Enumerate indications for labor induction
Membrane rupture without contractions
Gestational hypertension
Oligohydramnios
Postterm pregnancy
Chronic hypertension Diabetes
*NRFS
William’s 25th Ed, page 503
At what AOG do we induce a patient with:
A. chronic hypertension?
B. Chronic hypertension without severe features?
C. Chronic hypertension with severe features?
CH: 38 weeks
CH with SPE without SF: 37 weeks
CH with SPE with SF: 34 weeks
At what AOG do we induce a patient with:
A. Pre-eclampsia with severe features?
B. Pre-eclamspia without severe features?
PE without SF: 37 weeks
PE with SF: 34 weeks
At what AOG do we induce a patient with:
A. Gestational hypertension, controlled
B. Gestational hypertension, uncontrolled
GH, controlled: 37 weeks
GH, uncontrolled: 34 weeks
At what AOG do we induce a patient with
A. Gestational DM, diet-controlled
B. Gestational DM, insulin-requiring
C. Overt DM
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
At what AOG do we induce a patient with uncomplicated pregnancy?
41 weeks
ARRIVE TRIAL: 39 weeks
Enumerate MATERNAL contraindications to labor induction.
Contracted/distorted pelvis
Prior uterine incision type
Abnormal placentation
Active genital herpes
Cervical cancer
Enumerate FETAL contraindications to labor induction.
Macrosomia
Severe hydrocephalus
Malpresentation
NRFS
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
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.
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
C. BMI
Favorable factors:
Younger age
Multiparity
BMI <30
Favorable cervix
EFW < 3500grams
True or false.
Greater CS delivery risk associated with induction is like strongly influenced by the induction attempt duration.
True.
Bishop Score criteria.
Dilatation
Effacement
Station
Consistency
Position
Enumerate.
The simplified Bishop score includes which cervical factors? (3)
Dilation
Effacement
Station
Misoprostol has FDA approval for use in what condition?
A. Menorrhagia
B. Medical abortion
C. Labor augmentation
D. Peptic ulcer prevention
E. Intractable vomiting
D. Peptic ulcer prevention
This is the only biophysical marker that has been evaluated a Bishop score alternative.
Cervical length via TV-UTZ.
Dinoprostone is not available in which of the following formulations?
A. Gel
B. Vaginal suppository
C. Impregnated intracervical balloon
D. Timed-release vaginal insert
C. Impregnated intracervical balloon
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
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)
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. Irrigation to remove gel preparation has been shown to be helpful.
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
B. Pre-induction cervical ripening
Only the gel and insert forms are for cervical ripening.
Which of the following is a CONTRAINDICATION to dinoprostone use?
A. Glaucoma
B. 6 or more term pregnancies
C. Asthma
D. RBOW
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
True or false.
Misoprostol is superior than PGE2 when it comes to labor induction.
True.
Misoprostol is supperior/equal to PGE2.
True or false.
Nitric oxide donors are clinically more effective than prostaglandins.
False.
True or false.
Risk for chorioamnionitis is greater when extraamnionic saline infusion via transcervical catheter is done.
False.
Extraamnionic saline infusion (EASI) is constant saline infusion through the catheter into the space between the internal os and placental membranes.
These mechanical dilators draw water water from surrounding tissues and expand to geadually filate the cervical os.
Hygroscopic or osmotic dilators (eg. laminaria, Dilapan-S)
Additional info from chapter 15:
Shallow insertion: insufficient dilation
Deep insertion: dislodgment into the uterine cavity
Low dose of oxytocin is at _____ mU/min.
High dose is at _____ mU/min.
Low: 0.5-2 mU/min
High: 4-6mU/min
True or false.
Maximal effective dose of oxytocin to achieve adequate contractions in all women is different.
True.
At 20mU/min infusion of oxytocin, women are likely to have:
A. Diarrhea
B. Poor urine output
C. Tachycardia
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.
Early amniotomy (done at 1-2cm) reduces labor duation by __ hours.
4 hours.
Late amniotomy (at 5cm) accelerates spontaneous labor by ____ hours.
1-1.5 hours
Enumeration.
Amniotomy, aka surgical induction, increases risk of:
Chorioamnionitis
Cord prolapse
Abruptio (rare)
Failure of induction is defined as:
- no cervical change even with oxytocin augmentation for 24 hours
- no change for 18 hours even with ruptured bag of waters and adequate contractions
