Induction and Augmentation of labour

Question 1

Define Induction of labour

Answer 1

Artificial initiation of where by it is believed that the outcome of the pregnancy will be better if it is artificially interrupted rather than being left to follow its natural course Nice 2008

Question 2

What is a membrane sweep?

Answer 2

VE: Separation of chorionic membrane from the decidua and stimulate prostoglandin levels. Which increases the likelihood of spontaneous labour.

Question 3

When should a sweep be performed?

Answer 3

Primip: 40weeks and 41 weeks
Multip: 41 weeks

Question 4

Indication for induction?

Answer 4

Diabetes
Prevent prolonged pregnancy
PROM >37week (>24hours)
IUD

Question 5

What complications can arise?

Answer 5

Uterine hyperstimlulation
Uterine rupture
Cord prolapse

Question 6

What is used for inducing labour?

Answer 6

Vaginal prostaglandin E2 - PGH2

tablet, gel, pessary

Question 7

Management of PGH2 in each form?

Answer 7

tablet and gel- one does followed by a second if not in established labour 6hours

pessary one does over 24hours

If failed - women and fetus fully assessed (CTG)

further attempt at induction
caesarean

Question 8

What should be recorded prior to induction? X2

Answer 8

FH

Bishop score

Question 9

When is the women to contact the hospital after gel or tablet?

Answer 9

when contractions begin

has no contractions <6hours

Question 10

How to prevent hyperstimulation

Answer 10

tocolytic

Question 11

How to prevent cord prolapse

Answer 11

Before IOL: engagement of presenting part
palpate foe umbilical cord presentation
ARM avoid if head high

Question 12

What is the definition of augmentation of labour?

Answer 12

Augmentation of labour is the process of stimulating the
uterus to increase the frequency, duration and intensity of
contractions after the onset of spontaneous labour WHO 2014

Question 13

Indications for augmentation?

Answer 13

Confirmed delay in labour
Contraction insufficiently strong OR
uncoordinated to dilate cervix

Question 14

What is established delay in first stage of labour?

Answer 14

Primip: <2cm/4hours
multip:<2cm/4hours or slowing in progression

Question 15

If delay confirmed in 1st stage what should be the management?

Answer 15

Amniotomy bishop score >7 VE 2hours following if <1cm consider oxytocin

Question 16

What is the aim of oxytocin?

Answer 16

to increase frequency, strength of contractions

Question 17

How do you manage Oxytocin 1st stage?

Answer 17

Pain relief
increase every half hour until contraction 4-5:10 lasting 40-90sec
VE four hours following Oxytocin commenced
if <2cm obstetric r/v

Question 18

When is should delay be established 2nd stage labour?

Answer 18

primip: 2 hours refer
Multip: <1 hour refer

Question 19

Management of delay in second stage?

Answer 19

Offer VE and ARM- Primip: <1hour
Multip- <30mins
change position 
empty bladder 
supported pushing 
consider oxytocin with regional analgesia can be increased 15-20mins until 4:10