Induction of Labour

Question 1

Indications for IOL (14)

Answer 1

• prolonged pregnancy (>41wks)
• PROM
• pPROM >34wks
• IUGR/uteroplacental insufficiency
• IUD (intrauterine death)
• maternal medical conditions
• twins
• pre-eclampsia, eclampsia once stable
• fetal anomalies
• chorioamonitis
• oligo/anhydraminos
• abnormal uterine/umbilical artery dopplers
• non-reassuring CTG
• unexplained APH at term

Question 2

When should membrane sweep be offered?

Answer 2

• prior to formal IOL
• at 40 and 41wks antenatal visits (just 41wks for multips)
• when VE performed to assess cervix
• additional membrane sweep if labour does not start spontaneously

Question 3

When can membrane sweep be safely performed? (2 things)

Answer 3

• placenta praevia excluded

- cervix ripened enough to admit 1 finger

Question 4

Results of membrane sweep

Answer 4

30% spontaneous labour in <7 days, majority result in more favourable cervix

Question 5

Risks of IOL (6)

Answer 5

• prolonged duration of labour
• more likely to need regional anaesthesia, therefore also instrumental delivery (NOT CS)
• failure to get into established labour
• uterine hyperstimulation
• uterine rupture
• umbilical cord prolapse

Question 6

What Bishop’s score indicates a favourable cervix?

Answer 6

8+

Question 7

What is uterine hyperstimulation defined as?

Answer 7

contraction frequency >5 in 10mins or contractions >2mins duration

Question 8

What is the 1st line method of induction

Answer 8

vaginal prostaglandins (PGE2/ - dinoprostone) unless risk of uterine hyperstimulation

Question 9

What is the 2nd line method of induction

Answer 9

amniotomy (ARM - artificial rupture of membranes) +/- oxytocin

may be 1st line if risk uterine hyperstimulation

Question 10

Risk of ARM

Answer 10

cord prolapse

Question 11

Management of cord prolapse

Answer 11

• manually elevating fetal head
• place mother in prone knee-chest position (all 4s)
• can fill mother’s bladder with saline
• emergency CS if not fully dilated