Labor and delivery - Induction of labor

Question 1

Criteria for labor

Answer 1

• 1 in 10 mins contraction with atleast 200 mvu
• Cervical dilation >3 cm
• Cervical effacement of >70 to 80%

Question 2

Pre-induction assessment

Answer 2

• Confirmation of parity
• Confirmation of AOG
• Fetal presentation
• Bishop score
• Uterine acivivity
• NST
• Indication for induction
• Capability or LR/DR

Question 3

Bishop scoring is to determine what?

Answer 3

Assess cervical favorability

Question 4

Favorable cervix Bishop score

Answer 4

≥ 9

Question 5

Favorable cervix Bishop score

Answer 5

≤ 5

Question 6

Components of Bishop score

Answer 6

• Position
• Consistency
• Effacement
• Dilation
• Station
• Memory aid:*
• determines if labor PoCEDS

Question 7

Cervical position if the fetus is low down the cervix

Answer 7

Anterior

Question 8

Zero scores in Bishop scoring

• Position
• Consistency
• Effacement
• Dilation
• Station

Answer 8

• Position
  
  • Posterior
• Consistency
  
  • Firm
• Effacement
  
  • 0 - 30%
• Dilation
  
  • Closed
• Station
  
  • • 3
• Memory aid:*
• Zero PF, 30 C -3

Question 9

Scores of 1 in Bishop scoring

• Position
• Consistency
• Effacement
• Dilation
• Station

Answer 9

• Position
  
  • Midposition
• Consistency
  
  • Medium
• Effacement
  
  • 30 - 50% (middle)
• Dilation
  
  • 1 to 2 cm
• Station
  
  • • 2
• Memory aid:*
• 1 na! MMM 1 2 MMM 1 2 MMM 1 2 MMM

Question 10

Scores of 2 in Bishop scoring

• Position
• Consistency
• Effacement
• Dilation
• Station

Answer 10

• Position
  
  • Anterior
• Consistency
  
  • Soft
• Effacement
  
  • 50 to 70%
• Dilation
  
  • 3 to 4 cm
• Station
  
  • • 1

Question 11

Scores of 3 in Bishop scoring

• Position
• Consistency
• Effacement
• Dilation
• Station

Answer 11

• Position
  
  • N/A
• Consistency
  
  • N/A
• Effacement
  
  • > 80%
• Dilation
  
  • > 5 cm
• Station
  
  • +1, +2

Question 12

Bishop score modifiers

Answer 12

• Add 1 point for
  
  • Pre-eclampsia
  • Each previous vaginal delivery
• Subract 1 point for
  
  • Post-date pregnancy
  • Nulliparity
  • PPROM
• Memory aid:*
• Add 1 for the 2 PREs

Question 13

Indication or contraindication

1. GH
2. Malpresentation
3. CPD
4. Placenta previa
5. Preeclampsia, eclampsia

Answer 13

1. I
2. C/I
3. C/I
4. CI
5. I

Question 14

Indication or contraindication

1. Previous myomectomy
2. PROM
3. Maternal medical conditon
4. Invasive carcinoma of cervix
5. Gestation 41 1/7

Answer 14

1. C/I
2. I
3. I
4. C/I
5. I

Question 15

Indication or contraindication

1. IUFGR
2. Intraamniotic infection
3. Cord compression
4. Active herpes
5. Physician’s convenience

Answer 15

1. I
2. I
3. C/I
4. C/I
5. C/I

Question 16

Method of labor induction that has the potential to increase local prostaglandin, and may reduce pregnancy duration or pre-empt formal induction of labor with oxytocin or amniotomy

Answer 16

Membrane stripping

Question 17

Signs of oxytocin hyperstimulation

Answer 17

• Five (5) contractions in 10 minutes or more than 10 contractions in 20 minutes
• Hypertonus (contractions lasting more than 120 seconds)
• Excessive uterine activity with an atypical or abnormal fetal heart rate

Question 18

Early and late amniotomy

• Cervical diltation
• Accelerates labor by

Answer 18

• Early
  
  • 1 to 2 cm
  • 4 hours
• Late
  
  • 5 cm
  • 2 hours

Question 19

Complications of amniotomy

Answer 19

• Chorioamnionitis
• Umbilical cord prolapse
• Cord compression
• FHR deceleration
• Bleeding from fetal or placental parts