Induction and Augmentation of Labour

Question 1

What is a trial of scar?

Answer 1

A vaginal birth with a history of caesarean

Question 2

What are some methods of inducing labour?

Answer 2

Prostin E2 gel - softens and partly dilates the cervix
Amniotomy
Syntocinon

Question 3

When is prostaglandin gel contraindicated? What are the risks?

Answer 3

Previous caesarean

Uterine rupture

Question 4

What is an amniotomy?

Answer 4

Artificial breaking of the water with forceps via vaginal exam

Question 5

When don’t you do a amniotomy? Why?

Answer 5

When the head is not well applied to the cervix

Due to risk of cord prolapse

Question 6

What is syntocinon?

Answer 6

A posterior pituitary polypeptide that stimulates uterine muscle contraction

Question 7

What are some side effects of syntocinon?

Answer 7

Uterine hyperstimulation with subsequent fetal distress

Nausea, vomiting, hyponatraemia

Question 8

What are some side effects of IOL?

Answer 8

Cord prolapse
Uterine hyperstimulation
Fetal distress
Precipitant labour

Question 9

What percentage of induced labour fail? What do you do if it happens?

Answer 9

10%

Caesarean

Question 10

What is the purpose of instrumental delivery?

Answer 10

Facilitate or expedite vaginal delivery

Question 11

What the instruments used?

Answer 11

Nevile Barnes or Kielland’s forceps

Ventouse vacuum device

Question 12

What are Kielland’s forceps used for?

Answer 12

Rotation of the head

Question 13

At what levels of engagement can you instrument?

Answer 13

Mid
Low
Outlet

Question 14

Why do an instrumental delivery?

Answer 14

Delay in second stage of labour
- Maternal exhaustion 
- Excessively effective epidural 
- Malposition of presenting part
Fetal distress in second stage of labour

Question 15

What is the Franken-Hause plexus?

Answer 15

Plexus of nerve in the rectum that the baby’s head pressures stimulating contraction

Question 16

What is required for an instrumental delivery?

Answer 16

Second stage of labour (full dilation)
Fetal head should be engaged
Cephalic position
Adequate analgesia - epi, spinal, pudendal 
Lithotomy position (stirrups)
Catheter passed
Appropriate resuscitation facilities
Episiotomy - especially if forceps

Question 17

Which type of instrumentation requires a episiotomy?

Answer 17

Forceps (due to added diameter with forceps)

Question 18

When do you use each type of instrument?

Answer 18

Neville Barnes forceps for anterior positions

Ventouse for anterior or rotation from lateral or posterior and delivery

Question 19

When do you instrument in theatre?

Answer 19

When you’re not sure that it will work

Question 20

What are some complications of instrumentation?

Answer 20

Bruising
Facial nerve palsy
Intracerebral bleeding
Damage to cervical spine
Chignon and circular bruise
Subaponeurotic bleeding or intracerebral bleeding
Soft tissue tears and bruising to vagina and perineum