Induction of labour

Question 1

What is induction of labour?

Answer 1

The process where labour is started

Question 2

What are possible indications for the induction of labour?

Answer 2

• prolonged pregnancy >12 days after estimated date of delivery
• pre-labour premature rupture of the membranes, where labour does not start
• diabetic mother >38 weeks
• pre-eclampsia in mother
• fetal growth restrictions
• intrauterine death
• rhesus incompatibility

Question 3

At what stage should a diabetic mother be induced?

Answer 3

38 weeks

Question 4

At what stage in a prolonged pregnancy should a mother be induced?

Answer 4

More than 12 days after the estimated delivery date

Question 5

What medical maternal problems would require induction?

Answer 5

diabetic mother > 38 weeks
pre-eclampsia
obstetric cholestasis

Question 6

What is the function of the Bishop’s score?

Answer 6

Used to assess whether induction of labour will be required

Question 7

What does the Bishop’s score include?

Answer 7

Cervical position
Cervical consistency
Cervical effacement
Cervical dilation
Fetal station

Question 8

What are the points for cervical position?

Answer 8

Posterior- 0
Intermediate- 1
Anterior- 2

Question 9

What are the points for cervical consistency?

Answer 9

Firm-0
Intermediate- 1
Soft- 2

Question 10

What are the points for cervical effacement?

Answer 10

0-30%- 0
40-50%- 1
60-70%- 2
80%- 3

Question 11

What are the points of cervical dilatation?

Answer 11

<1 cm- 0
1-2 cm- 1
3-4 cm- 2
>5 cm- 3

Question 12

What are the points of fetal station?

Answer 12

-3- 0
-2- 1
-1- 2
0 +1,+2- 3

Question 13

What does a score of a score of < 5 on the Bishop scale indicate?

Answer 13

Labour is unlikely to start without induction

Question 14

What does a score of a score of >8 on the Bishop scale indicate?

Answer 14

That the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

Question 15

What are the possible methods of induction of labour?

Answer 15

membrane sweep
Intravaginal prostaglandin E2 (PGE2)
oral prostaglandin E1 (misoprostol)
artificial rupture of membranes
oral mifepristone + misoprostol

Question 16

What is the main complication of the induction of labour?

Answer 16

Uterine hyperstimulation

Question 17

What is uterine hyperstimulation?

Answer 17

Prolonged and frequent uterine contraction

Question 18

What is the management of uterine hyperstimulation?

Answer 18

Removing the vaginal prostaglandins if possible and stopping the oxytocin infusion if one has been started
consider tocolysis

Question 19

What is the management if the Bishop’s score is if the Bishop score is ≤ 6?

Answer 19

vaginal prostaglandins or oral misoprostol

Question 20

When would you consider using mechanical methods over vaginal prostaglandins or oral misprostol in someone with a Bishop’s score of less than 6?

Answer 20

Mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean

Question 21

What is the management if the Bishop score is > 6?

Answer 21

Amniotomy and an intravenous oxytocin infusion