Induction of Labour

Question 1

Foetal indications for induction?

Answer 1

Prolonged pregnancy
IUGR
Antepartum haemorrhage
Poor obstetric histroy
Pre-labour term rupture of membranes

Question 2

Materno-foetal indications for induction?

Answer 2

Pre-eclampsia/severe HTN
Uncontrolled diabetes
Renal disease

Question 3

Maternal indications for induction

Answer 3

Social reasons
In utero death
Malignany

Question 4

Contraindications to induction? (absolute)

Answer 4

Acute foetal compromise
Abnormal lie
Placenta praevia
Pelvic obstruction 
(more than 1 caesarean section)

Question 5

Relative contraindications to induction?

Answer 5

One previous caesarean section
Prematurity
Breech
High parity

Question 6

What needs to be done prior to induction?

Answer 6

Obstetric exam
MEWS score
CTG
Assess favorability of cervix (Bishop’s score)

Question 7

What is Bishop’s score? What indicates a favorable cervix?

Answer 7

Out of 10, 8 indicates favorable cervix

Position
Length
Consistency
Dilation
Station of presenting part

Question 8

What is membrane sweeping? Chance of success?

Answer 8

AKA stretch and sweep

Passing a finger through cervical os and ‘striping’ between membranes and lower segment of uterus

30% will go into spontaneous labour in 7 days - in majority, results in more favorable cervix

Question 9

What are vaginal prostaglandins and what do they do?

Answer 9

Prostaglandin E2 (PGE2) gel inserted into posterior vaginal fornix (Mistoprostol)

Two effects - promotes cervical ripening and uterine SM contraction

Preferred method of IoL (when Bishop’s score <8)

Question 10

What can you do if one dose of vaginal prostaglandin doesn’t work?

Answer 10

Another dose 6h later (providing there are no contractions) - more than 2 doses are not helpful

Question 11

What is ARM?

Answer 11

Artificial rupture of membranes (amniotomy) - forewaters ruptured with amnihook

Oxytocin infusion started within 2h if labour has not ensued

Question 12

What is oxytocin infusion and what is it used for?

Answer 12

Can be used to induce labour (if bishop’s score is high) - often used just to augment labour.

Synthetic form = syntocinon (IV infusion) - start at low dose and titrate to optimum contraction

Question 13

Complications of induction?

Answer 13

Foetal distress
Precipitate delivery - too quick
Longer labour
Instrumental/operative delivery
Uterine hypertonia (hyperstimulation) --> uterine rupture
Amniotic fluid embolism
PPH and intrapartum/postpartum infection more likely
Systemic effects