Induction of labour Flashcards
What is induction of labour?
The process where labour is started
What are possible indications for the induction of labour?
- 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
At what stage should a diabetic mother be induced?
38 weeks
At what stage in a prolonged pregnancy should a mother be induced?
More than 12 days after the estimated delivery date
What medical maternal problems would require induction?
diabetic mother > 38 weeks
pre-eclampsia
obstetric cholestasis
What is the function of the Bishop’s score?
Used to assess whether induction of labour will be required
What does the Bishop’s score include?
Cervical position
Cervical consistency
Cervical effacement
Cervical dilation
Fetal station
What are the points for cervical position?
Posterior- 0
Intermediate- 1
Anterior- 2
What are the points for cervical consistency?
Firm-0
Intermediate- 1
Soft- 2
What are the points for cervical effacement?
0-30%- 0
40-50%- 1
60-70%- 2
80%- 3
What are the points of cervical dilatation?
<1 cm- 0
1-2 cm- 1
3-4 cm- 2
>5 cm- 3
What are the points of fetal station?
-3- 0
-2- 1
-1- 2
0 +1,+2- 3
What does a score of a score of < 5 on the Bishop scale indicate?
Labour is unlikely to start without induction
What does a score of a score of >8 on the Bishop scale indicate?
That the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour
What are the possible methods of induction of labour?
membrane sweep
Intravaginal prostaglandin E2 (PGE2)
oral prostaglandin E1 (misoprostol)
artificial rupture of membranes
oral mifepristone + misoprostol
What is the main complication of the induction of labour?
Uterine hyperstimulation
What is uterine hyperstimulation?
Prolonged and frequent uterine contraction
What is the management of uterine hyperstimulation?
Removing the vaginal prostaglandins if possible and stopping the oxytocin infusion if one has been started
consider tocolysis
What is the management if the Bishop’s score is if the Bishop score is ≤ 6?
vaginal prostaglandins or oral misoprostol
When would you consider using mechanical methods over vaginal prostaglandins or oral misprostol in someone with a Bishop’s score of less than 6?
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
What is the management if the Bishop score is > 6?
Amniotomy and an intravenous oxytocin infusion
