Induction of labour

Question 1

Incidence

Answer 1

10-15% pregnancies

Question 2

Difference between induction and augmentation?

Answer 2

Induction - prior to spontaneous labour onset, with intact membranes

Augmentation - active labour has begun but is not progressing at an adequate rate

Question 3

Indications (foetal)

Answer 3

IUGR + foetal compromise

Worsening foetal abnormalities e.g. hydrops, TTTS

Question 4

Indications (Maternal)

Answer 4

Pre-eclampsia
Uncontrolled HTN
Deteriorating medical condition

Question 5

Obstetric indications

Answer 5

Pronlonged pregnancy
PROM
Anterpartum haemorrhage

Question 6

Main risks

Answer 6

Uterine hyperstimulation
Increased obstetric interventions
Risk of failed induction

Question 7

OSCE

Answer 7

1.Explain procedure + why patient needs it
2. Explain risks
3. Check - gestation, presentation and exclude CI
caution - previous uterine surgery and grand multiparity
4. Check cervix for Bishop’s score

Question 8

CI

Answer 8

Absolute:

• Acute foetal compromise
• Abnormal lie
• Placenta praevia
• Pelvic obstruction

Relative:

• previous uterine surgery
• prematurity
• High parity

Question 9

Success predictor

Answer 9

• gestational age on indiuction
• Parity
• Bishops score

Question 10

Bishops score

Answer 10

>6 = favourable cervix --> ARM + SYNTOCINON
<6 = may need ripening (prostaglandins, membrane sweep or oxytocin

Reassess in 6 hours

Question 11

ARM

Answer 11

Rupture with amnihook –> local prostaglandins for cervical ripening –> spontaneous labour in 90%

Foetal head must be engaged with cervix to avoid cord prolapse

Contractions, if don’t start in:

• primips 4hrs
• multip 2hrs
• -> oxytocin infusion

Question 12

Complications

Answer 12

• Inefficient uterine activity
• Instrumental delivery/LSCS
• Hyperstimulation –> foetal distress, uterine rupture
• PPH
• Infection
• Prematurity
• Systemic prostaglandin SE - N+V, diarrhoea, bronchoconstriction

Question 13

Cervical ripening methods

Answer 13

1. stretch and sweep –> releases prostaglandins (offered to nulliparous women 40-41 weeks, parous at 41 weeks)
2. PGE2 = preferred agent for cervical ripening - given INTRAVAGINALLY (posterior fornix)
   - Gel = Prepidil
   - Pessary = Propess
3. Oxytocin - used following ROM with favourable cervix or augmentation of prolonged labour (make sure it isn’t obstructed labour!)

NB. do not start oxytocin infusion <6hrs after prostaglandins