iol_flashcards
What does a high BISHOP score (≥8) indicate?
A favourable cervix with a high chance of spontaneous labour or response to interventions to induce labour.
What does a low BISHOP score (≤6) indicate?
Induction needed to start labour.
What does the station ‘0’ indicate?
The head is directly at the level of the ischial spines.
What does a station of -2 indicate?
The head is 2cm above the ischial spines.
What does a station of +2 indicate?
The head is 2cm below the ischial spines.
What method of induction is offered for a BISHOP score ≤6?
Offer IOL with vaginal prostaglandin first. If not suitable, offer mechanical method such as balloon catheter or osmotic cervical dilator.
What method of induction is offered for a BISHOP score >6?
Offer IOL with ARM followed by IV oxytocin infusion.
What are the indications for IOL?
Pregnancy >41 weeks, PPROM, PROM, previous Caesarean birth, maternal request, breech position, foetal growth restriction, suspected foetal macrosomia, IUFD.
What is membrane sweeping and when is it offered?
Membrane sweeping involves inserting a gloved finger through the cervix and rotating around the inner rim. It’s offered to prevent prolongation of pregnancies, starting from 40 weeks in nulliparous women and 41 weeks in multiparous women.
When is vaginal prostaglandin E2 offered and how is it administered?
Offered 1st line if low BISHOP score (≤6) or no progress 24 hours after membrane sweep. Administered as vaginal tablet, gel, or pessary.
What is the mechanical method for inducing labour and why is it used?
A catheter with a balloon (cervical ripening balloon) is inserted into the cervix. It is preferred over vaginal prostaglandin during Covid to avoid uterine hyperstimulation.
When is ARM offered and what are its risks?
Offered if BISHOP score >6, not first-line for low BISHOP score. Risks include umbilical cord prolapse.
When is IV Syntocinon offered and what are its risks?
Offered if BISHOP score >6 or if labour has not ensued 2 hours after membranes rupture. Risks include uterine hyperstimulation and increased risk of uterine rupture.
What is the summary process for induction of labour?
Membrane sweep to stimulate prostaglandins, vaginal PGE2 or mechanical balloon, ARM if no ROM, IV Syntocinon after 2 hours of ARM.
What should be done if induction fails?
Rest period followed by another attempt or C-section if there is no major threat to foetal or maternal condition.
