IOL

Question 1

What was the finding of the Cochrane review looking at IOL for women with normal pregnancies at or beyond 37/40

2020

Answer 1

Fewer:

• Perinatal deaths
• Admissions to NICU
• CS
• Stillbirth

NO difference to:

• perineal trauma
• PPH
• breastfeeding at discharge

This review did not answer the question of gestation, as most studies were looking at > 39/40 and some included post-dates

Question 2

When comparing balloon IOL to PGs, what risks are reduced

Cochrane

Answer 2

• Uterine hyperstimulation
• Serious neonatal morbidity or perinatal death
• NICU admission

Question 3

When comparing balloon IOL to PGs, what risks are increased

Cochrane

Answer 3

Nil

Increases the risk of CS when compared to MISOPROSTOL

Question 4

What was the finding of the Cochrane Review looking at membrane sweeping for IOL

2020

Answer 4

Membrane sweeping is:
- more likely to be associated with
spontaneous onset of labour
- less likely to be associated with IOL.

No difference to

• CS rate
• SVD rate
• maternal death or serious morbidity
• neonatal perinatal death or serious morbidity

Question 5

What should your IOL counselling cover?

Answer 5

• Indication for IOL
• When, where, how and who will carry out IOL.
• Support and analgesia options
• Risks and benefits of IOL in specific circumstances and proposed IOL method.
• IOL does not increase risk of CS or neonatal morbidity.
• Alternative options if she declines IOL.
• IOL may not be successful and what options would be.

Question 6

What is the incidence of fetal dysmaturity syndrome post-dates?

Outline the complications/risks associated with fetal dysmaturity syndrome (chronic intrauterine malnutrition)

Answer 6

20%

• Meconium passage and aspiration syndrome.
• Oligohydramnios and placental insufficiency leading to fetal distress.
• Perinatal morbidity: hypoglycaemia, polycythaemia, perinatal asphyxia, persistent pulmonary HTN, neurodevelopmental complicaitons.

Question 7

What % of pregnancies continue beyond 42 weeks?

Answer 7

5-10%

Question 8

What are the risks associated with a stretch and sweep?

Answer 8

Minor risks:

• Discomfort
• Vaginal bleeding

Question 9

What % of prelabour rupture of membranes will labour spontaneously by 24 hours?

Answer 9

70%

Increases to 95% by 96 hours.

Question 10

What were the findings of the TERMPROM trial 1996?

Answer 10

IOL with oxytocin had significantly:

• lower rates of chorioamnionitis (half)
• intrapartum fever (half)
• postpartum fever (half)
• NICU admission (half)

NO difference to rates of CS

Question 11

What were the major findings of the ARRIVE trial?

Answer 11

IOL at 39+0 to 39+4 vs expectnant mgmt for low-risk nulliparous women with no indication for IOL.

Outcomes:

• No difference between groups in primary outcomes (perinatal death, severe neonatal complications).
• IOL NOT associated with adverse perinatal and maternal outcomes.
• Significant reduction in CS delivery for IOL group
• Significant reduction in HTN disorders for IOL group.

Question 12

What is the risk of uterine hyperstimulation with PGs?

PG E2

Answer 12

4.8%

Compared with 1% with placebo or no treatment

Question 13

What are the risks of Misoprostol IOL (PGE1) compared to PGE2 IOL>?>

Answer 13

Almost three-fold higher risk of uterine hyperstimulation

RANZCOG

Question 14

What are the rates of uterine rupture in women with previous CS, having PGs?

Answer 14

1.4-2.5%

RANZCOG