Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

My MRCOG Part 2 > Module 7 - NICE 207 +TOGs - Inducing Labour > Flashcards

Module 7 - NICE 207 +TOGs - Inducing Labour Flashcards

1
Q

Define tachysystole

A

> 5 contractions in 10 minutes
For more than 20 minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define hyperstimulation

A

Overactivity of uterus (as result of IOL).
Tachysystole or hypertonicitiy with or without CTG changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define hypertonicity

A

Contraction lasting > 2minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If unable to carry out membrane sweep via the cervical os, what alternative method of membrane sweep can be used?

A

Massaging the fornicies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define precipitate labour.

A

Baby born within 3 hours of onset of labour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What proportion of pregnancies are induced?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What information should be given to women about the medicalisation of of IOL?

A

Increased number of VEs
Limited places to deliver
Possibly limit pool use
Increased risk of instrumentals (therefore increased risk of OASI)
Hyperstimulation
Longer labour and hospital stay.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the risks of IOL?

A

Increased pain
Increased risk of instrumentals (therefore increased risk of OASI)
Hyperstimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the stillbirth rate according to MBRRACE in white women?

A

34 / 10,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the stillbirth rate according to MBRRACE in black women?

A

x2 of white women
74 / 10,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the stillbirth rate according to MBRRACE in Asian women?

A

x1.5 of white women
53 / 10,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What needs to be ruled out before IOL or membrane sweep is carried out?

A

A low lying placenta or placenta previa.
Non-cephalic lie.
Regular contractions.
(also ensure normal CTG).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is Bishop Score calculated?

A

Dilatation
(0: 0cm dilated.
1: 1-2cm dilated.
2: 3-4cm dilated.
3: 5-6cm dilated).

Position
(0: posterior
1: mid
2: anterior).

Effacement
(0: 0-30%
1: 40-50%
2: 60-70%
3: 80%+).

Station
(0: -3
1: -2
2: -1 to 0
3: +1 to +2).

Consistency
(0: Firm
1: Medium
2: Soft).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When can foetal monitoring can be reverted to IA during IOL process?

A

If CTG is normal and woman is low risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the difference in IOL outcomes between inpatient and outpatient IOL?

A

There is no difference in outcomes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When should women undergoing outpatient IOL contact mw?

A

PVB.
SROM.
RFM.
No contractions within set timeframe.
Lost pessary/mechanical induction.
Onset of contractions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What type of hormone is misoprostol?

A

PGE1
(Prostaglandin E1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the dose of misoprostol?

A

Range based on gestation (800 to 25 micrograms).
Reduces with gestational age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of hormone is dinoprostone?

A

PGE2
(Prostaglandin E2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the maternal side effects of misoprostol?

A

Flactulence
Diarrhoea
Abdominal pain
FEVER
Nausea and vomiting
Shivering
PVB
Headache
SINUS TACHYCARDIA
(hyperstimulation, uterine rupture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the duration of action and peak onset of action of misoprostol when given:
1. PO
2. Sublingual
3. PV
4. Buccal

A
  1. (PO) Duration of action - 2 hours
    Peak onset in 30 mins.
  2. (SL) Duration of action - 3 hours
    Peak onset in 30 mins.
  3. (PV) Duration of action - 4 hours
    Peak onset in 70-80 mins.
  4. (Buc) Duration of action - unknown.
    Peak onset in 70-80 mins.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the contra-inductions to dinoprostone use for IOL?

A

Active cardiac or pulmonary disease (including severe asthma).
Untreated pelvic infection.
Major CPD.
Hepatic or renal impairment.
Uterine surgery.
SROM.
Grand multip (>P4).
Foetal distress.
Foetal malpresentation.

(Caution in asthma, glaucoma, raised intra-ocular pressure, epilepsy, DIC and HTN).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the potential SEs of Dinoprostone?

A

Fever
Infection
Hypotension
PV Itching or burning
Uterine atony
GI upset
Genital oedema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is used for tocolysis?

A

Terbutaline 250 micrograms SC.
Up to 2 doses.
Repeat can be given after 30 minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Above what Bishop Score should ARM and syntocinon be offered as method of IOL?

A

6+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Below what Bishop Score should mechanical or pharmacological IOL be offered?

A

Less than 6.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What method of IOL has the lowest risk of hyperstimulation?

A

Mechanical IOL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What method of hormonal IOL is associated with the lowest risk of hyperstimulation?

A

PO Misoprostol <50 micrograms.
(OR 1.5 compared to spontaneous labour).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the increased risk of hyperstimulation when dinoprostone PV TABLETS are used, compared to spontaneous labour?

A

OR 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the increased risk of hyperstimulation when dinoprostone PV GEL are used, compared to spontaneous labour?

A

OR 3.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the increased risk of hyperstimulation when dinoprostone PV pessary are used, compared to spontaneous labour?

A

OR 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the increased risk of hyperstimulation when misoprostol SL or Buccal routes are used to induce labour, compared to spontaneous labour?

A

OR 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What monitoring should be offered to women who are >42/40?

A

Twice weekly CTGs and weekly deepest pool.

34
Q

Beyond what gestation is there no difference in meconium aspiration risk, HIE or instrumental delivery rates?

35
Q

What % of women will labour spontaneously before 31 weeks?

36
Q

What proportion of women will labour spontaneously in each week between 32 and 37+6 weeks?

37
Q

What proportion of women will labour spontaneously in their 38th week of pregnancy?

38
Q

What proportion of women will labour spontaneously in each week in their 39th week of pregnancy?

39
Q

What proportion of women will labour spontaneously in their 40th week of pregnnacy?

40
Q

What proportion of women will labour spontaneously in their 41st week of pregnancy?

41
Q

If a women has not laboured by 42 weeks, what is the chance that she will spontaneously labour?

42
Q

What are the benefits of membrane sweep?

A
  • Increased chance spontaneous labour (therefore reduced need for IOL).
  • No increase in infection rate.
  • Shortens IOL to delivery time.
43
Q

Is membrane sweep safe for GBS carriers?

44
Q

What is the NNT for membrane sweep to induce one labour?

45
Q

What type of IOL balloon has the shortest IOL to delivery time?

A

Follys catheter.

(cooks double balloon is longer).

46
Q

What is the difference in LSCS and PPH rate between balloon IOL compared to prostaglandin IOL?

A

There is no difference in PPH or LSCS rates.

47
Q

What is the balloon catheter volume for folly’s and cook’s catheter?

A

Folly’s - 30mls
Cook’s - 80mls.

48
Q

Which balloon is associated with greater maternal satisfaction?

A

Cook’s balloon.

49
Q

What are the risks associated with balloon IOL methods?

A

Foetal malposition
Increased cord pH
Infection.

50
Q

Does balloon traction or taping catheter to thigh affect outcomes?

51
Q

What is the difference in APGAR scores between balloon catheter and misoprostol?

A

There is NO difference.

52
Q

What additional procedure can be considered after double balloon catheter has been inserted, to aid with IOL?

A

EASI
Extra-Amniotic Saline Infusion.

53
Q

What are Laminaria?

A

Seaweed based IOL rods (seaweed Dilapans).

54
Q

What is the mechanism of action of Dilapan?

A

Dehydrates the cervix.
Applies pressure on the cervix.
Swells the cervix.
Causes local prostaglandin and oxytocin release.

55
Q

How many dilapan should be used for IOL?

56
Q

Is dilapan or Laminaria associated with a shorter IOL to delivery time?

A

Dilapan is associated with a shorter IOL to delivery time.

57
Q

What methods of IOL are NOT supported by evidence?

A

IV/PO Dinoprostone.
PV PGF2.
IV Oxytocin alone (ie no ARM).
Herbal supplements.
Acupuncture.
Hyaluronidase.
Oestrogen.
Relaxin.
Homeopathy.
Corticosteroids.
Caster oil.
Mifeprostone (except IUFD).
PV N.O Donors (GTN or isosorbate mononitrate).
Sex.
Enemas.

58
Q

For what method of IOL is LSCS rates lowest.

A

Lowest for low dose PO misoprostol - 21%

(highest for high dose PV misoprostol).

59
Q

What is the rate of hypersimulation with low dose oral misoprstol?

60
Q

What is the rate of hypersimulation with dinoprostone?

61
Q

Where is oxytocin produced?

A

In the hypothalamus.

(then stored in and released by posterior pituitary).

62
Q

Where does oxytocin act on?

A

Uterine receptors.
NO ACTION ON CERVIX.

63
Q

What are the risks of oxytocin use in IOL?

A

Increased surgical intervention.
Increased rates of foetal heart rate concerns.

64
Q

What is EASI?

A

Extra-Amniotic Saline Infusion.
Aims to strip membranes from decidua.
No increased infection rate.
Historically used for IUFD IOL.

65
Q

What should be done in the case of failed IOL?

A

Fully reassess including CTG.
Discuss rest and retry IOL, expectant mx or LSCS.

66
Q

What precautions can be taken to prevent cord prolpase?

A
  • Do not dislodge head.
  • Assess engagement (PA).
  • Palpate for cord on VE.
  • If PP not well applied or stable after SROM then start cCTG.
67
Q

What is the risk of uterine rupture in VBAC when induced?

A

1%
(double of VBAC spontaneous labour).

68
Q

At what gestation is post dates pregnancy defined?

69
Q

What are the risks that are increased after 41/40?

A

Increased LSCS,
Increased NNU admission,
Increased stillbirth/ neonatal death.

70
Q

What affect does IOL at 41/40 have on LSCS rates?

A

Reduces LSCS rates (compared to serial CTG monitoring).
No difference in perinatal morbidity and mortality.

71
Q

What is the risk of perinatal death (when mixed partity data is considered) for women at 41/40 compared to women at 42 or 43/40?

A

At 41/40: 4 / 10,000

At 42-43/40: 35 / 10,000.

SIGNIFICANT INCREASE AT 42/40.

72
Q

Below what gestation should IOL NOT be carried out in PPROM patients?

A

<34/40
(unless there is an obstetric indication)

73
Q

How is PPROM managed?

A

Expectant management until 37/40

(unless GBS positive 34-37/40 - then consider risks and balances and d/w patient).

74
Q

What options can be offered for PROM at term?

A

Expectant management for 24 hours.
But augment immediately if GBS positive.

75
Q

Can IOL be offered in IUGR?

A

Yes, unless there is confirmed foetal compromise (e.g. raised dopplers).

76
Q

Define foetal macrosomia.

77
Q

What is the risk of IOL for LGA?

A

Increased rates OASI.

(no difference in LSCS, brachial plexus or perinatal death rates).

78
Q

What is the benefit of IOL for LGA?

A

Reduces risk of shoulder dystocia.
(no difference in LSCS, brachial plexus or perinatal death rates).

79
Q

Should women who have had a previous precipitous labour be routinely offered IOL?

80
Q

By how much is the rate of requiring an LSCS increased when women who have had a VBAC are induced?

A

1.5x increased risk of requiring LSCS

My MRCOG Part 2 (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions