induction of labour

Question 1

urgent indiciaations for IOL

Answer 1

severe pre-eclampsia/HELLP syndrome
chorioamnionitis
confirmed foetal compromise of IUGR
- abnormal CTG
- abnormal dopplers
prolonged ruptured membranes

Question 2

priority indications for IOL

Answer 2

oligohydramnios
diabetes
gestational hypertension
cholestasis
fetal demise
rhesus isoimunicaation

Question 3

non urgent indications for IOL

Answer 3

gestation over 41 weeks + 3 (offered routinely at 41 weeks)
confirmed macrosomia
uncomplicated twins
advanced maternal age (increases risk of stillbirth)

Question 4

why is IOL offered for post dates

Answer 4

increased risk of stillbirth/perinatal deth
macrosomia
birth trauma
intrapartum asphyxia
PPH
c/s rate
perinatal mental health issues

Question 5

stages of IOL

Answer 5

cervical ripening
artificial rupture of membranes
stimulate contractions

Question 6

cervical ripening

Answer 6

natural - stretch and sweep
hormonal - prostaglandins, prostin gel, misopristol
mechanical - transcervical catheter, osmotic dilator

Question 7

modified bishop score

Answer 7

tool to assess readiness of patient’s cervix to dilate, by DVE

Question 8

bishop score >/=8 means

Answer 8

favourable cervix associated with an increased chance of being responsive to IOL interventions

Question 9

methods of cervical ripening

Answer 9

mechanical: stretch and sweep or transcervical balloon catheter
pharmacological: PGE2 pessary (cervidil) or PGE2 gel

Question 10

prostaglandins

Answer 10

pharmacological methods when bishop score <8
PG E2 gel: 1-2 mg doses
cervidil: 10mg controlled release pessary

Question 11

transervical catheter

Answer 11

non-pharmacological method
saline-filled balloon with 80ml sterile water pressure to the lower uterus and cervix resulting in local production of prostaglandins and cervical ripening
can be removed quickly if required, less likely to cause uterine hyperstimulation

Question 12

PGE2 pessary/cervidil

Answer 12

tape containing PGE2 placed around the posterior fornix

Question 13

PGE2 gel

Answer 13

applied to the posterior fornix

Question 14

what is excessive uterine activity

Answer 14

uterine tachysystole: >5:10 contractions without FHR abnormalities
uterine hypertonus: contractions >2 minute duration or occurring within 60 seconds of each other without FHR abnormalities
uterine hyperstimulation: either one of these but WITH FHR abnormalities

Question 15

artificial rupture of membranes

Answer 15

amnicot or
amnihook

Question 16

why do you need a formal rupture of membranes

Answer 16

hindwaters may have broken (waters behind the baby)
but sometimes there is. plug of forewaters that need to be broken as well

Question 17

complications of oxytocin

Answer 17

delaayed breast milk production
uterine hyperstimulation
hyponatraemia
hypotension

Question 18

stimulation of uterine contractions

Answer 18

IV oxytocin infusion (syntocinon)
to establish uterine activity sufficient to induce cervical change and fetal descent
contraction frequency of 3-4:10
with 60s duration, 60s break in between

Question 19

dosing of syntocinon infusion

Answer 19

starting dose 12ml/hr
increase infusion rate every 30 minutes

Question 20

when to start oxytocinon infusion

Answer 20

leave 6 hours after PGE2 gel administration
leave 30 minutes of PGE2 pessary removal
use with caution in grand multiparity or VBAC

Question 21

complications of IOL

Answer 21

hyperstimulation of the uterus
uterine rupture (if pt had a previous c-section)
fetal immaturity
umbilical cord prolapse following ARM

Question 22

contraindications for IOL

Answer 22

placenta praevia, vasa praevia, malpresentation
known cephalopod-pelvic disproportion
acute foetal compromise
cord presentation or prolapse

maternal - active herpes, HIV positive, maternal refusal

Question 23

things to consider before starting IOL

Answer 23

review patient history and pregnancy
confirm gestational age
any contraindications for IOL
abdominal palpation
CTG and monitoring
VE
bishop score

Question 24

what if IOL is unsuccessful

Answer 24

inform the obstetric consultant
rest period prior to reassessment
?C/S