Induction of Labour and Intrapartum Care

Question 1

What is induction of labour?

Answer 1

Planned initiation of labour prior to spontaneous onset

Question 2

How common is induction of labour?

Answer 2

Occurs in up to 25%

Question 3

Why is induction of labour performed?

Answer 3

Presumed risk to mother/foetus of continuing pregnancy > risk of induction of labour = should only be performed if there is reasonable chance of success

Question 4

What are the maternal indications for induction of labour?

Answer 4

Pre-eclampsia, poor obstetric history, medical disorders

Question 5

What are the foetal indications for induction of labour?

Answer 5

Suspected IUGR, rhesus iso-immunisation, PROM, antepartum haemorrhage

Question 6

What are some other indications for induction of labour?

Answer 6

Post date pregnancy, diabetes, obstetric cholestasis

Question 7

What criteria are assessed in the Bishops score?

Answer 7

Consistency, position, dilatation, length, station

Question 8

What would give a Bishops score of 0?

Answer 8

Firm consistency, posterior position, 0-1cm dilatation, length of 2-4cm, station of -3

Question 9

What would give a Bishops score of 1?

Answer 9

Average consistency, mid position, 1-2cm dilatation, length of 1-2cm, station of -2

Question 10

What would give a Bishops score of 2?

Answer 10

Soft consistency, anterior position, 2-4cm dilatation, length of 0.5-1cm, station of -1 or 0

Question 11

What would give a Bishops score of 3?

Answer 11

Dilatation >4cm, length <0.5cm, station below the ischial spines

Question 12

What are the methods of induction of labour?

Answer 12

Prostaglandins, mechanical, amniotomy, IV syntocinon

Question 13

How are prostaglandins used to induce labour?

Answer 13

PGE2 Dinoprostone = prostin gel or propess pessary

Question 14

What are the mechanical methods of induction of labour?

Answer 14

Membrane sweep, Foley balloon dilation

Question 15

What observations are taken during the intrapartum period?

Answer 15

Hourly pulse, 4 hourly temperature and BP, vaginal examination 4 hourly, 30-60 mins contractions, frequency of urine passage

Question 16

What pain relief can be given during the intrapartum period?

Answer 16

Non-opioids, entonox, opioid, epidural, remifentanyl

Question 17

When should foetal monitoring be done during the intrapartum period?

Answer 17

For 1 min after a contraction
Every 15 mins in 1st stage of labour
Every 5 mins in 2nd stage
Continuous CTG monitoring

Question 18

How is delay during labour managed?

Answer 18

Amniotomy or C-section

Syntocinon contractions every 4-5mins, increments every 30mins

Question 19

What is the active management of the second stage of labour?

Answer 19

Routine use of uterotonic drugs

Deferred clamping and cutting of cord

Question 20

What is active management of the second stage of labour associated with?

Answer 20

Nausea and vomiting, haemorrhage of >1L and need of blood transfusion

Question 21

What is the physiological management of the second stage of labour?

Answer 21

No use of uterotonic drugs
No clamping of cord until pulsation has stopped
Delivery of placenta by maternal effort

Question 22

What would be classed as delay in the third stage of labour?

Answer 22

Not completed within 30mins of birth with active management or 60mins with physiological management

Question 23

How is delay in the third stage of labour managed?

Answer 23

Manage with MROP under anaesthetic

Question 24

What is the treatment of post partum haemorrhage?

Answer 24

Empty bladder, uterine massage, uterotonic drugs, IV fluids, controlled cord traction if placenta not yet delivered