Induction of Labour

Question 1

Why is IOL needed?

Answer 1

If the labour is prolonged
Maternal/fetal problems

Question 2

Indications - list some

What score can be used to assess whether induction of labour is necessary?

Answer 2

PROM
Growth restriction
PE
Obstetric cholestasis
Existing DM
Intrauterine fetal death :(

Post-term pregnancy
Signs of fetal distress
Placental insufficiency
Oligohydramnios
IUGR
Maternal problems (e.g. PE, GDM)
PROM - chorioamnionitis
Stillbirth

Bishop score

Question 3

Contraindications?

Answer 3

Prematurity
Major placenta praevia or cord prolapse
Transverse lie - can be considered if a breech
Previous uterine rupture or classical (vertical) CS

LOOK UP REASONS

Question 4

Method - First line:

–Membrane sweep - Insert finger into cervix to stimulate - When is this started?

–Vaginal Prostoglandin’s E2 - types?

Cervical ripening balloon - Silicone balloon inserted into cervix (Usually for multiparous women (>3) )

Answer 4

Antenatal clinic - From 40 weeks - women over their EDD

Prostin (PGE2) - vaginal gel
Propress pessary
–Release prostoglandins over 24 hrs

Question 5

Method - Second line:

Artificial rupture of membranes:
- What does this stand for?
- What is used to do it?
- What is this given with?

Method - Third line:
- What med is given IV?
- How are the doses given?

Intrauterine death (Anti-progesterone given) + misoprostol to induce labour

Answer 5

Amnihook - look up

Oxytocin IV

Low dose and titrate up

Question 6

Adverse effects:

What expected effect do they have on contractions?

Uterine hyperstimulation:
- Criteria? - 2

What obs emergency could happen if the head is not yet engaged?

Management is to remove prostaglandins or stop infusion

Answer 6

Painful contractions

Contraction > 2 minutres
5 or more contractions in 10 mins

It can cause impairment to uteroplacental blood flow and result in fetal heart rate abnormalities, fetal hypoxia and fetal damage.

Cord prolapse

Question 7

Bishop Score:

What is it used to determine?

Above what score suggests predicts successful induction?

Answer 7

A score of 8 or more predicts a successful induction of labour.

A score below this suggests cervical ripening may be required to prepare the cervix.