Induction and augmentation of Labour

Question 1

What should you always do before induction? (7)

Answer 1

Give full information about induction
Check woman's history for any risk factors
Check location of the placenta
Check maternal wellbeing (obs)
Check fetal wellbeing (CTG)
Gain consent
Do a VE to ascertain Bishop's Score

Question 2

What pharmocological methods are used for induction? (reference)

Answer 2

Prostaglandins (PGE2) are used for IOL (NICE 2008)

Question 3

How is PGE2 given for IOL?

Answer 3

EIther as two doses of gel or tablet 6 hours apart or as a pessary for 24 hours.

Question 4

What happens after administration of gel or tablet PGE2?

Answer 4

CTG is put on following administration and if OK, auscultation is commenced. CTG should be put on once contractions start again. VE should be repeated after 6 hours

Question 5

What happens after the administration of PGE2 pessary?

Answer 5

CTG put on following administration and if ok, intermittent auscultation started. CTG when contractions have started. VE should be repeated 24 hours later unless woman is in established labour.

Question 6

When should an outpatient induction contact the ward?

Answer 6

After 6 hours or when contractions start

Question 7

What does NICE (2008) say about membrane sweeps and when should they be given for primips and multips?

Answer 7

Membrane sweeps make it more likely that a woman will go into labour spontaneously but are not considered as a form of induction. NICE (2008) advises that midwives offer primips one at 40 and 41 weeks and multips one at 41 weeks.

Question 8

What happens if IOL fails?

Answer 8

Assess maternal and fetal wellbeing and consider a repeat IOL or LSCS

Question 9

What risk factors does IOL pose?

Answer 9

Uterine rupture
Epidural
Placental abruption if placenta over os

Question 10

When is IOL recommended during IUD?

Answer 10

If there is bleeding, infection or there has been rupture of membranes, IOL is recommended. If woman is healthy and well she can have expectant management or IOL.

Question 11

What drugs are used to induce IUD labour?

Answer 11

PGE2 and Mifeprostone

Question 12

How does NICE (2008) define IOL?

Answer 12

The process where it is believed the outcome of the pregnancy will be better if it is artificially terminated.

Question 13

Define augmentation of labour? (include reference)

Answer 13

WHO (2011) defines augmentation as the process of stimulating the uterus to increase the frequency, strength an dlength of contractions to expedite birth.

Question 14

What is the incidence of IOL? (include reference)

Answer 14

29.4% - 2016/17 NHS Statistics

Question 15

What is the main reason women have IOL and why? include evidence.

Answer 15

To prevent prolonged pregnancy. Galal et al. (2014) suggests prolonged pregnancy is associated with fetal and maternal morbidity and mortality.

Question 16

List all the reasons a woman may have IOL?

Answer 16

Prolonged pregnancy
PROM <34 weeks (IOL would not be done before 34 unless indicated)
Previous CS
Maternal hypertension
Maternal request in exceptional circumstances

Question 17

If a woman has PROM when can she have IOL?

Answer 17

24 hours after pre-labour rupture of membranes

Question 18

List 2 contraindications for IOL

Answer 18

IUGR
Fetal distress
Breech

Question 19

What does NICE (2008) say about non-pharmacological methods of induction?

Answer 19

There is no evidence to support them.

Question 20

What is important about the midwifery care of a women undergoing augmentation?

Answer 20

WHO (2014) states women undergoing augmentation should never be left alone.

Question 21

Can ARM be done in conjunction with oxytocin for augmentation? What is the evidence?

Answer 21

Yes, usually if a Bishop’s score is 7+. Howarth and Botha (2001) found that combining ARM with Oxytocin made delivery quicker and reduced the need for instrumental deliveries however, it increased the risk of PPH.

Question 22

What is the purpose of synthetic oxytocin in augmentation of labour? how is it increased?

Answer 22

To stimulate contraction of the uterus to 4:10 lasting 40-90 seconds. Regimes vary between hospitals but generally increase every 30 minutes until the desired effect is achieved,

Question 23

What is given as an antidote to oxytocin in the event of uterine hyperstimulation?

Answer 23

tocolytic

Question 24

What are some roles of the midwife in augmentation of labour?

Answer 24

Facilitating women’s choice
Ensuring she is fully informed
Giving individual care at all times
Pain relief and safe medicines management
Rapid action if hyper stimulation occurs.