Induction Of Labour Flashcards
Induction of Labour
Use of medications to stimulate the onset of labour
Indications for induction of labour
Over the due date - 41 - 42 weeks Prelabour rupture of membranes Fetal growth restriction Pre-eclampsia Obstetric cholestasis Existing diabetes Intrauterine fetal death
What is the Bishop Score used for
Used to determine whether to induce labour
What does the Bishop score entail
Fetal station (scored 0 – 3) Cervical position (scored 0 – 2) Cervical dilatation (scored 0 – 3) Cervical effacement (scored 0 – 3) Cervical consistency (scored 0 – 2)
According to the bishop score, when should induction of labour occur
Score of 8 +
Options for induction of labour
Membrane sweep
Vaginal prostaglandins
Cervical ripening balloon
Artificial rupture of membranes
Oracle mifepristone
Membrane sweep
Involves inserting a finger into the cervix to stimulate the cervix and begin the process of labour.
Performed in antenatal clinic
Should produce the onset of labour within 48 hours.
Used from 40 weeks gestation to attempt to initiate labour in women over their EDD.
Not full induction of labour
Vaginal prostaglandin
Slow release of local prostaglandins over 24 hours
This stimulates the cervix and uterus
Done in the hospital setting so that the woman can be monitored before being allowed home to await the full onset of labour
Cervical ripening balloon (CRB)
Silicone balloon that is inserted into the cervix and gently inflated to dilate the cervix.
Alternative where vaginal prostaglandins are not preferred:
- previous caesarean section, where vaginal prostaglandins have failed
- multiparous women (para ≥ 3).
Artificial rupture of membranes
Oxytocin infusion
When vaginal prostaglandins not used
Can be used to progress the induction of labour after vaginal prostaglandins have been used
Oral mifepristone + misoprostol
Used to induce labour where intrauterine fetal death has occurred
Monitoring during the induction of labour
Cardiotocography (CTG) - assess the fetal heart rate and uterine contractions before and during induction of labour
Bishop score before and during induction of labour to monitor the progress
Ongoing Management of induction of labour if slow or no progress
Most women give birth within 24 hours of the start of induction of labour
The options when there is slow or no progress are:
- Further vaginal prostaglandins
- Artificial rupture of membranes and oxytocin infusion
- Cervical ripening balloon (CRB)
- Elective Caesarean section
Complication of induction of labour with vaginal prostaglandins
Uterine hyperstimulation
Uterine hyperstimulation
Where the contraction of the uterus is prolonged and frequent, causing fetal distress and compromise
