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Year Three - Reproductive System > Labour Induction > Flashcards

Labour Induction Flashcards

1
Q

What is labour induction?

A

It is the stimulation of uterine contractions during pregnancy, before labour begins on its own, to achieve a vaginal birth

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2
Q

When is labour induction generally indicated?

A

When it is thought that delivering the baby will be safer for the baby and the mother, than for the baby to remain in utero

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3
Q

What are the four specific indications of labour induction?

A

Prolonged Gestation

Prelabour Rupture of Membranes

Maternal Health Problems

Fetal Health Problems

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4
Q

At what gestation do we offer labour induction?

A

40 - 42 weeks

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5
Q

What are the two risks of prolonged gestation, hence why we offer labour induction?

A

Fetal compromise

Stillbirth

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6
Q

What is prelabour rupture of membranes?

A

It is the term used when a patient’s waters have broken prior to labour starting

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7
Q

What four maternal health problems indicate labour induction?

A

Hypertension

Pre-eclampsia

Diabetes

Obstetric cholestasis

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8
Q

What three fetal health problems indicate labour induction?

A

Fetal Growth Restriction

Oligohydramnios

Intrauterine Fetal Death

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9
Q

What is fetal growth restriction? At what estimated weight percentile?

A

It is a condition in which a fetus is smaller than expected for its gestational age

< 10th percentile

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10
Q

What is oligohydraminos?

A

It refers to amniotic fluid volume that is less than expected for the gestational age

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11
Q

What is intrauterine fetal death?

A

It is when a fetus dies inside the womb before birth

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12
Q

What are the two general categories of labour induction contraindications?

A

Absolute

Relative

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13
Q

What are absolute contraindications of labour induction?

A

They define events that could cause a life-threatening situation, and therefore induction is essential

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14
Q

What are the seven absolute contraindications of labour induction?

A

Cephalopelvic Disproportion

Vasa Praevia

Placenta Praevia

Prolapsed Umbilical Cord

Active Primary Genital Herpes

Foetal Distress

Oblique Lie

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15
Q

What are relative contraindications of labour induction?

A

They define events that should be approached with caution, however, are frequently performed

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16
Q

What are the three relative contraindications of labour induction?

A

Breech Presentation

Maternal Asthma

Previous C-Section

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17
Q

What are the five mechanisms of labour induction?

A

Membrane Sweep

Vaginal Prostaglandins

Cervical Ripening Balloon (CRB)

Amniotomy

Prostaglandin Analogues

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18
Q

What is a membrane sweep?

A

It is performed by inserting a gloved finger through the cervix and rotating it against the fetal membranes

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19
Q

How does a membrane sweep induce labour?

A

This separates the chorionic membrane from the decidua

The separation releases natural prostaglandins in an attempt to initiate labour

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20
Q

When are membrane sweep mechanisms recommended?

A

In patients who have a prolonged gestation date between 40 - 42 weeks

It is not considered a full method of inducing labour and is more of an assistance before full induction

By performing it, the likelihood of spontaneous delivery increases, reducing the need for a formal induction

21
Q

What is another name for vaginal prostaglandins E2?

A

Dinoprostone

22
Q

What is prostaglandins?

A

A hormone

23
Q

What is prostaglandins?

A

A hormone

24
Q

What are the two functions of prostaglandins?

A

It ripens the cervix

It contracts the smooth muscle within the uterus

25
Q

When is vaginal prostaglandins recommended?

A

It is the preferred management option when cervical ripening has not yet occurred, usually indicated by a Bishop’s score less than six

26
Q

What is the cervical ripening balloon procedure?

A

It involves the insertion of a silicone balloon into the cervix to prepare it for labour by ripening it

27
Q

When is cervical ripening balloon recommended?

A

This induction method is only selected if cervical ripening has not yet occurred, usually indicated by a Bishop’s score less than eight

It is used as an alternative where vaginal prostaglandins is not preferred

28
Q

In which three circumstances is vaginal prostaglandins not preferred to induce labour?

A

A previous c-section

When prostaglandins has failed

In multiparous women > 3

29
Q

What is amniotomy?

A

It is where the membranes are ruptured artificially using an instrument called an amniohook

This process releases prostaglandins

30
Q

What do we administer following amniotomy? Why?

A

An infusion of artificial I.V oxytocin

This is used to achieve adequate contractions

31
Q

What contraction rate should we aim during labour induction?

A

4 contractions every 10 minutes

32
Q

When is amniotomy recommended to induce labour?

A

When cervical ripening has occurred

33
Q

Name two prostaglandin analogues

A

Mifepristone

Misoprostol

34
Q

When are prostaglandin analogues recommended to induce labour?

A

When intrauterine fetal death has occurred

35
Q

In what two ways do we monitor labour induction?

A

Bishop score

Cardiotocography

36
Q

What is the bishop score?

A

It is a pre-labour scoring system used to predict whether induction of labour will be required

It can also be measured during induction of labour to monitor the progress

37
Q

What are the five criteria of the bishop score?

A

Dilatation (cm)

Cervix length (cm)

Position

Consistency

Fetal Station

38
Q

What does a bishops score > 8 indicate?

A

A successful induction of labour

39
Q

What does a bishops score < 8 indicate?

A

A score less than eight suggests cervical ripening may be required to prepare the cervix before induction

40
Q

What does a bishops score < 5 indicate?

A

Labour induction

41
Q

What does a bishops score < 5 indicate?

A

Labour induction

42
Q

How is cardiotocography (CTG) used to monitor labour induction?

A

It is used to assess the fetal heart rate and uterine contractions

It is also used following an oxytocin infusion, to monitor the stimulated contractions

43
Q

What are the three complications of labour induction?

A

Induction Failure

Uterine Hyperstimulation

Cord Prolapse

44
Q

How do we manage induction failure?

A

We can offer these patients a further cycle of prostaglandins or a c-section

45
Q

What is uterine hyperstimulation?

A

It occurs when the contraction of the uterus is prolonged and frequent

46
Q

What labour induction mechanism is associated with uterine hyperstimulation?

A

Prostaglandins

47
Q

What are the three complications of uterine hyperstimulation?

A

Foetal Distress

C-Section

Uterine Rupture

48
Q

How do we manage uterine hyperstimulation?

A

We administer tocolytic agents, such as terbutaline

49
Q

What labour induction mechanism is associated with cord prolapse?

A

Amniotomy, particularly if the presentation of the fetal head is high

Year Three - Reproductive System (52 decks)

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