Drugs to Induce Labour and Manage a PPH

Question 1

When is an IOL offered in non-complicated pregnancies?

Answer 1

Women with uncomplicated pregnancies should usually be offered
induction of labour between 41+0 and 42+0wks to avoid the risks of
prolonged pregnancy.

Question 2

When is a membrane sweep offered?

Answer 2

• 40wks for Nullips

* 41wks for Multips

Question 3

What is a membrane sweep?

Answer 3

Insert a finger through the
cervix and firmly move finger
around in a circular motion,
separating the membranes of
the amniotic sac from the
cervix.

Question 4

What are the prostaglandins used for IOL?

Answer 4

-PGE1 (misoprostol) tablet
-PGE2 (Dinosprostone) gel/pessary
-PGF2α
(Hemabate)

Question 5

What is the IOL process?

Answer 5

It should be administered as a gel, tablet or controlled-release pessary
• one cycle of vaginal PGE2 tablets or gel: one dose, followed by a second dose after 6 hours if labour is not established (up to a maximum of two doses)
• one cycle of vaginal PGE2 controlled-release pessary: one dose over 24 hours

Question 6

Contraindications of IOL

Answer 6

Fetal compromise i.e. Intrauterine growth restriction, fetal distress
• Previous caesarean section (caution)
• Maternal request (not routinely offered)
• Twins
• Malpresentation i.e. Transverse/Breech
• Hx of precipitate labour (grand multiparity)
• Placenta praevia/ vasa praevia, undiagnosed vaginal bleeding
• Known or suspected CPD
• Severe pre-eclampsia

Question 7

What is syntocinon used for?

Answer 7

Inducing/stimulating labour (after Cx ripening)
(infusion)
• Augmenting labour – when contractions are
considered not effective (infusion)
• Active management of 3rd stage (IM)
• Treatment of Post Partum Haemorrhage (PPH)
(Infusion)
• Prophylactically at C/S by anaesthetist to prevent
PPH (IV)

Question 8

What is the Tocolytic agent?

Answer 8

• Tocolysis should be considered if uterine hyperstimulation occurs during
induction of labour.
• Uterine hyper stimulation: >5:10 or lasting >90seconds
• Works on the smooth muscle of the uterus
• Works to inhibit contraction
• Terbutaline:
• 250mcg SC- review. Can give up 500mcg SC

Question 9

List of medications for PPH

Answer 9

Ergometrine- midwives can only give 2 doses of this= 1mg
Syntometrine 500mcg Egometrine, 5IU Syntocinon
Syntocinon: 40 units, given in 500 mL infusion fluid
Hemabate /carboprost: 250mcg (0.25mg) IM every 15mins

Question 10

Ergometrine?

Answer 10

 Can be given IM or IV
 Contracts all smooth muscles
 500mcg ampoule
 Works within 45 seconds IV (slowly)
 IM acts within 3-7 minutes
 Side effects – N&V, headaches, increase in BP
 Contraindications – High BP, severe liver, kidney or cardiac disorders, pregnancy