Induction of Labour

Question 1

What are the maternal indications for IOL?

Answer 1

1. Pre-eclampsia @ 37 weeks
2. Diabetes M @ 39 weeks (if on insulin?)
3. Poor obstetric history (trauma)
4. APH
5. Maternal request

Question 2

What are the fetal indications for IOL?

Answer 2

1. Pre-eclampsia
2. Post term 41-42 weeks
3. FGR @ 37 weeks
4. Twins @ 38-39 weeks (36 MC, 34 MC MA)
5. Fetal death
6. PROM
7. Reduced fetal movements
8. Fetal abnormality

Question 3

What are the complications of IOL?

Answer 3

1. It can fail and need a CS
2. Increased obstetric intervention
3. Uterine hyperstimulisation - fetal hypoxia
4. Cord Prolapse
5. Prologued labour - risk of PPH

Question 4

How do you decide the method of IOL?

Answer 4

Bishop score
6 or more = favourable = ARM +/- oxytocin
5 or less = vaginal prostaglandins (gel/pessary)

Question 5

How do you calculate the bishop score?

Answer 5

length of cervix, dilation, consistency, position, station

Question 6

What examinations are indicated in IOL?

Answer 6

Bishop score –vaginal exam
Reassess after prostaglandins (6hrs)
SFH=dates? Head engaged?
ARM –volume and color of liquor

Continuous CTG monitoring once membranes are ruptured and oxytocin (IV) commenced

Question 7

Whats the difference between augmentation of and induction of labour?

Answer 7

Induction vs Augmentation: Induction of labour and augmentation of labour are performed for different indications, but the methods are the same. Induction of labour: stimulating the uterus to begin labour. Augmentation of labour: stimulating the uterus during labour to increase the frequency, duration and strength of contractions.