Induction of labour

Question 1

indications

Answer 1

prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
prelabour premature rupture of the membranes, where labour does not start
diabetic mother > 38 weeks
pre-eclampsia
rhesus incompatibility

Question 2

what is the bishops score?

Answer 2

used to help assess the whether induction of labour will be required.

Question 3

what components does the bishop score measure?

Answer 3

Cervical position

Cervical consistency

Cervical effacement

Cervical dilation

Fetal station

Question 4

what does the scoring for bishops score indicate?

Answer 4

a score of < 5 indicates that labour is unlikely to start without induction

a score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

Question 5

methods

Answer 5

membrane sweep

vaginal prostaglandin

maternal oxytocin infusion

amniotomy

cervical ripening balloon

Question 6

complications

Answer 6

uterine hyperstimulation

Question 7

what is uterine hyper stimulation

Answer 7

the main complication of induction of labour
refers to prolonged and frequent uterine contractions - sometimes called tachysystole

Question 8

what are the potential consequences of uterine hyper stimulation?

Answer 8

intermittent interruption of blood flow to the intervillous space over time may result in fetal hypoxemia and acidemia

uterine rupture (rare)

Question 9

Mx of uterine hyper stimulation

Answer 9

removing the vaginal prostaglandins if possible and stopping the oxytocin infusion if one has been started

tocolysis with terbutaline