Induction of labour

Question 1

How often does induction of labour happen?

Answer 1

1/4 of pregnancies

Question 2

Name 5 indications for an induction of labour

Answer 2

Pretty much anything:

Prolonged pregnancies
HT
DM
Basically any other medical condition (renal, liver, thrombophilia, red cell isoimmunisation etcccc)
Likely placental insufficiency (small for dates, oligohydramnios, poor foetal movements)
PROM
APH with normally sited placenta
Social (like if their partner is about to go overseas or something)

Question 3

What are the 3 main general risks of induction of labour?

Answer 3

Risks of birth happening earlier than it would spontaneously (respiratory, poor feeding)
Risks from method of induction
Risk of C/S from failed induction

Question 4

What score is used to assess whether the cervix is good for induction? What are its components?

Answer 4

Bishop’s score

I-ffacement
Station
Hardness (consistency)
Open/closed (dilatation)
Position (anterior is best)

Question 5

Name 3 C/I to induction of labour

Answer 5

C/I to vaginal delivery (malpresentation, praevia, vasa praevia, herpes)
C/I to oxytocic use (anything that raises risk of uterine rupture - grand multipara, uterine scar)
C/I to AROM (high, mobile presenting part that raises risk of cord prolapse)

Question 6

In addition to assessing the cervix, what other examination should you do before inducing a woman?

Answer 6

Foetal examination - make sure foetus isn’t in distress

Question 7

Name the 2 ways of ripening a cervix. Name the major SEs.

Answer 7

Pharmacological - prostaglandins (misoprostal tablet, gel, pessary). SE - excessive uterine contractions (= decreased blood to foetus), can also thin muscle of lower uterine segment and cause uterine rupture
Surgical - Foley catheter (pass balloon catheter through cervix, helps it dilate). SE - infection and chorioamnionitis

Question 8

Once the cervix is ripe (either naturally or after your interventions), name 2 things that might be necessary to get labour going. Are they always necessary? Why/why not?

Answer 8

Artificial rupture of membranes, followed by oxytocin infusion to stimulate contractions

Not always necessary, might happen spontaneously, or might happen because of your cervical ripening methods (especially prostaglandins - can be sufficient to induce labour)

Question 9

What’s one thing to keep in mind in terms of oxytocin infusions if you’ve used prostaglandins to ripen the cervix?

Answer 9

Should have a reduced rate of infusion - the two can synergise to cause uterine hyperstimulation (too forceful contractions), that can cause uterine rupture

Question 10

Can you induce labour in a woman with a previous C/S? Why/why not?

Answer 10

No! Need spontaneous labour, risk of uterine rupture is too high