Induction of labour

Question 1

A 30-year-old presents at 41 weeks gestation for induction of labour. How would you manage?

Answer 1

Impression:
Fetal and maternal mortality starts to rise after 41weeks gestation, so would consider need for induction of labour (IOL) if no spontaneous labour. IOL from 41+0 weeks is associated with less morbidity and mortality.

Question 2

Induction of labour - History

Answer 2

History

• Confirm GA, EDD.
• RISK: fam Hx, past prolonged pregnancy
• O&G Hx: GTPAL, yellow book,

Question 3

Induction of labour - Examination

Answer 3

Examination

• General appearance + vitals
• normal antenatal checks: abdo palp for position and station
• digital examination: membranes, cervical ripening/length
• speculum examination if required
• TV US for assessment of cervical length, TA US for assessment of fetal condition,
• CTG

Question 4

Induction of labour - Investigations

Answer 4

Investigations
- Modified bishops score: assesses likelihood of labour occurring naturally, and the need for an induction. considers cervical length, consistency, cervical dilation, fetal position and station

Question 5

Induction of labour - Management

Answer 5

Management/counselling
- escalate to O&G reg for review and management input

Registrar will consider following options for IOL, depending on findings of assessment. Four main options for IOL;
Cervical dilation techniques
- Dinoprostone (gel, pessary)
- Mechanical (balloon catheter)
Other
- Artificial rupture of membranes
- Syntocinon (stimulate uterine contractions)