Induction of Labour

Question 1

What is induction of labour?

Answer 1

Artificially starting labour.

Question 2

What are the main indications for inducing labour?

Answer 2

Fetal:

• Prolonged pregnancy >42 weeks
• Pre labour term spontaneous rupture of membranes
• IUGR

Maternal:

• Gestational diabetes
• Pre-eclampsia
• Chronic renal/pulmonary disease

Question 3

What are the contraindications to induction of labour?

Answer 3

Maternal:

• Cannot cope with labour due to serious chronic illness
• Active genital herpes

Fetal:

• Malpresentation
• Fetal distress

Placental:

• Cord prolapse
• Placenta previa
• Previous classical c-section (longitudinal scar)

Question 4

What is the bishop’s score what does it assess?

Answer 4

Cervical status:

Dilation
Effacement 
Station 
Consistency 
Cervical position 

Don’t Ever State Conservatives Care

Score of 15 higher score is more favourable for labour

Question 5

What are the different methods of inducing labour?

Answer 5

Membrane sweeping. (separation of the membranes from the cervix leads to the release of endogenous prostaglandins)

Prostaglandin gel or pessary.

Oral prostaglandin (misoprostol)

Oxytocin with/or without artificial rupture of membranes.

Question 6

What do you need to do when using prostaglandins to induce labour?

Answer 6

CTG 30mins before induction
CTG after medication
VE after 6 hours

Do not start oxytocin if PG’s were used for 6 hours.

Question 7

What do you need to do when using syntocin to induce labour?

Answer 7

Start on the lowest possible dose (1-4mU/min)

Double every 30 mins until optimal contractions have been reached (3-4 in 10mins) or max dose 40mU/min.

Continuous CTG monitoring

Check U/e’s if used for more than 12hrs as has a similar effect as ADH therefore can cause dilutional hyponatraemia.

Question 8

What are the complications of inducing labour?

Answer 8

Higher rates of C-section
Higher rates of medical interventions
Hyper stimulation
PPH