Obs: L&D - IOL

Question 1

what is induction of labour?

Answer 1

refers to use of medications to stimulate onset of labour

Question 2

indications for induction of labour

Answer 2

• over due date - offered between 41 and 42 weeks
• Prelabour rupture of membranes
• Fetal growth restriction
• Pre-eclampsia
• Obstetric cholestasis
• Existing diabetes
• Intrauterine fetal death

Question 3

what is the bishop score

Answer 3

scoring system used to determine whether to induce labour

assessing 5 things:

• Fetal station (scored 0 – 3)
• Cervical position (scored 0 – 2)
• Cervical dilatation (scored 0 – 3)
• Cervical effacement (scored 0 – 3)
• Cervical consistency (scored 0 – 2)

score 8 or more = sucessful IOL

below 8 = cervical ripening may be required to prepare cervix

Question 4

what are the options for IOL?

Answer 4

• membrane sweep
• vaginal prostaglandin E2 (dinoprostone)
• cervical ripening balloon
• artificial rupture of membranes
• oral mifepristone plus misoprostol

Question 5

describe a membrane sweep

Answer 5

involves inserting a finger into the cervix to stimulate the cervix and begin the process of labour

can be performed in antenatal clinic and if successful should produce labour within 48 hours

used from 40 weeks in an attempt to induce in women over due date

not considered full method of inducing labour - assistance before full IOL

Question 6

describe the use of vaginal prostaglandin E2 - dinoprostone

Answer 6

inserting a gel, tablet or pessary into the vagina

pessary slowly releases local prostaglandins over 24 hours

stimulates the cervix and uterus to cause onset of labour

Question 7

describe the use of cervical ripening balloon

Answer 7

silicone balloon that is inserted into the cervix and is gently inflated to dilate cervix

used as an alternative when vaginal prostaglandins are not preferred (previous cs, vaginal pros have failed, multiparous)

Question 8

when is artificial rupture of membranes with oxytocin infusion used?

Answer 8

only when cant use vaginal prostaglandins

can be used to progress the induction of labour after vaginal prostaglandins have been used

Question 9

how is labour induced when there has been intrauterine fetal death?

Answer 9

oral mifepristone and misoprostol

Question 10

what are the 2 ways of monitoring during the induction of labour

Answer 10

cardiotocography to assess fetal heart rate and uterine contractions

bishop score before and during IOL to monitor progress

Question 11

most women will give birth within 24 hours of the start of IOL - what are some options when there is slow or no progress

Answer 11

further vaginal prostaglandins

artificial rupture of membranes and oxytocin infusion

cervical ripening balloon

elective caesarean section

Question 12

what is uterine hyperstimulation

Answer 12

main complication of induction of labour with vaginal prostaglandins. it is where the contraction of the uterus is prolonged and frequent causing fetal distress and compromise

Question 13

criteria for uterine hyperstimulation vary, but what are 2 criteria that are common across trusts?

Answer 13

individual uterine contractions lasting more than 2 minutes

more than five uterine contractions every 10 minutes

Question 14

what are some complications of uterine hyperstimulation?

Answer 14

fetal compromise, with hypoxia and acidosis

emergency cs

uterine rupture

Question 15

what is the management of uterine hyperstimulation

Answer 15

removing the vaginal prostalgandins or stopping the oxytocin infusion

tocolysis with terbutaline