Intrapartum Care - Induction of Labour

Question 1

What is Induction of Labour?

Answer 1

Use of medications to stimulate the onset of labour - artificial.

Question 2

Indications of Induction of Labour (2G).

Answer 2

1. Week 41/42 Gestation.
2. Risk :
   2A. Prelabour Rupture of Membranes.
   2B. FGR.
   2C. PET.
   2D. Obstetric Cholestasis.
   2E. Existing Diabetes.
   2F. Intrauterine Foetal Death.
   2G. Rhesus Incompatibility.

Question 3

What is the Bishop Score?

Answer 3

A scoring system used to determine whether to induce labour.

Question 4

What is the Bishop Scoring System? (5).

Answer 4

1. Foetal Station : 0-3.
2. Cervical Position : 0-2.
3. Cervical Dilation : 0-3.
4. Cervical Effacement : 0-3.
5. Cervical Consistency : 0-2.

Question 5

Interpretation of Bishop Score (3).

Answer 5

1. Total Score between 0-13.
2. 8+ - Cervix is Ripe/Favourable : High Chance of Spontaneous Labour or Successful Induction of Labour.
3. 5+ - Labour is Unlikely without Induction : Cervical Ripening is required.

Question 6

What are the Options for Induction of Labour?

Answer 6

1. Membrane Sweep.
2. Vaginal Prostaglandin E2 Dinoprostone.
3. Cervical Ripening Balloon (CRB).
4. Artificial Rupture of Membranes (with Oxytocin Infusion).
5. Oral Mifepristone and Misoprostol.

Question 7

What is the preferred method of induction of labour?

Answer 7

Vaginal Prostaglandins.

Question 8

How is Membrane Sweep performed? (3)

Answer 8

1. Vaginal Examination First.
2. Insert a finger into the cervix to stimulate the cervix and begin labour.
3. Aim : Separate chorionic membrane from the decider.

Question 9

Indications of Membrane Sweep (2).

Answer 9

1. Assisting before full induction - not a method of induction.
2. Week 40 Gestation.

Question 10

When is a Membrane Sweep performed? (3)

Answer 10

1. Nulliparous - Week 40/41.
2. Parous - Week 41.
3. Can be done in antenatal clinic and should produce onset of labour within 48 hours.

Question 11

How does the Vaginal Pessary work? (3)

Answer 11

1. Similar to a tampon - slowly releasing local Prostaglandins over 24 hours.
2. Stimulate cervix and uterus to cause onset of labour.
3. Hospital Setting - needs monitoring before being allowed home.

Question 12

How does Cervical Ripening Balloon (CRB) work?

Answer 12

Silicone ballon inserted into the cervix and gently inflated to dilate the cervix.

Question 13

When is CRB used? (3)

Answer 13

Alternative to Vaginal Prostaglandins e.g. :

1. Previous C-Section.
2. Failure of Prostaglandins.
3. Multiparous Women (>2).

Question 14

When are Oral Mifepristone and Misoprostol used?

Answer 14

Induce labour where intrauterine foetal death has occurred.

Question 15

Monitoring of Induction of Labour (2).

Answer 15

1. Cardiotocography.

2. Bishop Score.

Question 16

Management of Failure to Progress in Labour (4).

Answer 16

1. Further Vaginal Prostaglandins.
2. Artificial Rupture of Membranes and Oxytocin Infusion.
3. Cervical Ripening Balloon (CRB).
4. Elective C-Section.

Question 17

What is the main complication of Induction with Vaginal Prostaglandins?

Answer 17

Uterine Hyperstimulation/Tachysystole - prolonged frequent uterine contractions.

Question 18

Diagnostic Criteria of Uterine Hyperstimulation (2).

Answer 18

1. Individual Uterine Contractions Lasting 2+ Minutes.

2. 5+ Uterine Contractions every 10 Minutes.

Question 19

Consequences of Uterine Hyperstimulation (3).

Answer 19

1. Foetal Compromise : Hypoxia and Acidosis.
2. Emergency C-Section.
3. Uterine Rupture.

Question 20

Management of Uterine Hyperstimulation (2).

Answer 20

1. Removing Vaginal Prostaglandins or Stopping Oxytocin Infusion.
2. Tocolysis with Terbutaline.