Induction of Labour

Question 1

Name some Maternal indications for beginning an Induction of Labour

Answer 1

Post Dates
PROM 
Diabestes 
Hypertension 
Cholestasis 
Obstetric History

Question 2

Name some Fetal indications for beginning an Induction of Labour

Answer 2

IUGR
Macrosomia 
Non-reassuring fetal wellbeing studies 
Iso-Immunisation 
Fetal Death

Question 3

Contraindications to Induction of Labour

Answer 3

Placenta previa 
Transverse lie or compound presentation
HIV +ve not on treatment or with a viral load of 400copies/ml or more 
Active genital herpes 
Cord presentation/prolapse 
Acute fetal compromise
Known cephalo-pelvic disproportion

Question 4

Complications associated with Induction of Labour

Answer 4

Failure of induction
Uterine hyperstimulation
Fetal distress
Ruptured uterus
Hypertonic contractions greater than 2 mins
Infection
Increased risk of operative vaginal birth, increased risk of birth trauma and increased risk of PPH

Question 5

When should the midwife consider offering a membrane sweep or ‘stretch and sweep’?

Answer 5

Primiparous women- 40 wks of gestation and 41 wks of gestation
Multiparous women- 41 wks of gestation

Question 6

If the cervix is long and closed what is an alternative to membrane sweeping?

Answer 6

Massaging around the vaginal fornix may produce similar effects

Question 7

Side effects of membrane sweeping?

Answer 7

Possible spotting

Possible painful and irregular cramping

Question 8

According the the bishops score, when can prostaglandins be administered?

Answer 8

When the bishops score is less than 5

Question 9

Mechanism of action of prostaglandins?

Answer 9

Replicate prostaglandin produced in early labour to ripen the cervix leading to relaxation dilatation

Question 10

What are the two common types of prostaglandins?

Answer 10

Prostin Gel - 1mg (Multips) or 2mg (Primips) repeated does must be at least 6 hrs apart. Max dose 3 mg.

Cervidil 1x 10mg pessary removed at or before 12 h rs. Slow release

Question 11

Care before administration of prostin

Answer 11

Abdominal Palpation: lie, presentation, descent
Pre- Prostin CTG (should also be repeated after administration)
Ensure that her bladder is empty

Question 12

Name three mechanical methods for cervical ripening

Answer 12

Foley’s Catheter
Atad catheter
Laminara tents

Question 13

Indication for ARM

Answer 13

To induce labour if cervix is favourable and presenting part is fixed in pelvis

Question 14

What should an ARM be performed with (usually)

Answer 14

Amnihook

Question 15

Does research show that an ARM alone is the most effective way to begin an induction of labour.

Answer 15

No. Research demonstrated that an ARM should be used with a syntocinon infusion if the woman does not establish into labour within 4 hrs

Question 16

What dose of synto is usually used?

Answer 16

10IU in 1000ml of Hartmans or N/Saline

Question 17

How often should the dose of synto be titrated

Answer 17

Every 30 minutes according to incramental syntocinon infusion regime

Question 18

Risks of synto infusion

Answer 18

Uterine hyperstimulation 
Fetal hypoxia and axphysia 
Uterine rupture 
Fluid retention 
PPH 
AFE