Induction of Labour

Question 1

What is the induction of labour?

Answer 1

Process of causing labour to commence ( and continue)

Question 2

What is augmentation of labour?

Answer 2

Process of stimulating labour which has already been commenced.

Question 3

What are the key reasons to induce labour?

Answer 3

• Post maturity (40 +)
• Fetal death utero
• Diabetes
• Ruptured membranes and chorioamnionitis
• Fetal Growth Restrictions
• Fetal compromise
• Blood group iso-immunisation
• Placental abruption
• Twin pregnancy
• Significant fetal anomaly ( termination)
• Poor past obstetric history
• Social

Question 4

What are reasons to not to induce labour?

Answer 4

• Prematurity
• Fetal Growth Restrictions
• Placenta praevia
• Fetal compromise
• Breech presentation or transverse lie
• Previous caesarian section
• Significant cephalopelvic distortion

Question 5

Name the three methods of induction of in step wise fashion. What they do? What are things to look out for?

Answer 5

1. Prostin E2 - ripens, softens, dilates the cervix
   - May induce uterine hyper-stimulation with fetal distress
   - Precipitates labour or uterine rupture
   - Should not be used with previous uterine scar or ruptured membranes
   - CTG - monitoring is used before and after
2. Amniotomy (ARM)
   - A hook or small toothed forceps is used to rupture the forewaters.
   - beware of the cord prolapse if presenting part is not well applied
   - Cervix needs to be dilated to allow aminotomy
3. Syntocinon
   - Stimulates uterine muscle contractions
   - Dosage is 1-32 milli-units/ ml
   - Beware of uterine hyperstimulation with subsequent fetal distress - CTG monitoring
   - Side effects of: Nausea, vomiting water intoxication and hyponatremia

Question 6

Why is instrumental delivery necessary?

Answer 6

Delay in the second stage of labour

• fetal exhaustion
• Effective epidural
• Malposition of the presenting part

Fetal distress in second stage of labour (monitored with CTG), requires the delivery to be expedited.

Question 7

What are the complications of instrumental delivery?

Answer 7

• Incorrect application of forces
• Baby is superficially bruised, facial nerve palsy, intercerebral bleed, damage to the cervical spine

Ventouse

• Leaves temporary chignon
• may cause subaponeurotic bleeding
• Intercerebral bleed

To mother

• Cause soft tissue tears
• bruising of vagina and perineum