Induction & Augmentation of Labour

Question 1

Understand the reasons for augmentation or induction of labour

Answer 1

Reasons for induction:
> Mother:  
   - DM, PE or HTN, Renal Dx  
   - obstetric hx, social choice
> Placenta, Membranes
   - PROM / chorioamnionitis
   - abruption  
> Fetal:  overdue 40+10w, twin preg, IUGR, fetal compromise (fetal movements, CTG)

(NB: don’t induce for all prem, FGR or compromised babies - as may not be able to handle induction, better off with CS)

Augmentation
- labour slow to progress, fetal compromise

Question 2

Distinguish between augmentation and induction of labour

Answer 2

Induction: causing labour to commence & continue

Augmentation: stimulating a labour once it’s started

Question 3

Describe the methods available for augmentation and induction of labour.
And the score used to predict success.

Answer 3

Induction

1) Prostaglandins: cervical ripening; beware uterine hyperstimulation
2) AROM (amniotomy) - hook to rupture membranes –> rel PGE2 & myometrial contractions; beware cord prolapse if head not engaged
3) Syntocin - stimulates uterine m contractions, titrate upwards + cont CTG; Ergometrine or Oxytocin (PE)

Augmentation
- misoprostol

Question 4

Appraise the advantages and disadvantages of inducing labour

Answer 4

Advantages

• choice timing delivery (specialists, social)
• ensure maternal & fetal health

Disadvantages

• premature baby
• +/- CS
• chorioamnionitis risk if prolonged induction
• Atonic PPH

Question 5

Understand the indications for an instrumental delivery

Answer 5

• Delay in 2nd stage labour
• Maternal exhaustion or effective epidural (decreased urge push)
• Malpresentation, shoulder dystocia
• Fetal distress 2nd stage

Question 6

Describe the devices available for instrumental delivery

Answer 6

Forceps
> Neville Barne’s: used deliver OA
> Keilland’s: used rotate OP –> OA

Ventouse vacuum: used for descent & rotation

Question 7

Describe the risks to the mother and baby of an instrumental delivery

Answer 7

Mother
- higher risk episiotomy / tears (added 2cm for forceps): soft tissue tears & bruising to perineum

Baby

• fracture cervical spine (e.g. Keilland’s forceps rotating to OA)
• facial nerve palsy
• bruising, temporary chignon/circular mark (Ventouse)
• intracerebral bleeding