OGCO-C3.5 Induction of labor

Question 1

What are 2 factors that decide method of induction?

Answer 1

1. The indication and urgency
2. The ripeness of the cervix as determined by MODIFIED BISHOP’S SCORE.

Question 2

When induction of labor offered for post term>

Answer 2

Induction any time between 41 weeks 2 days and 41 weeks 6 days is acceptable when the EDC is reliable.

Question 3

If women does not induction of labor after 41 weeks of gestation, what is done?

Answer 3

fetal monitoring should be started and the inadequacy of fetal monitoring should be explained. NST monitoring twice weekly and scan to check for growth problems and liquor volume are needed.

Question 4

What does the modified Bishops score include?
What is a favorable score for combined induction?

Answer 4

Question 5

When is cervical ripening considered?

Answer 5

Cervical ripening considered for unfavorable cervix in term, singleton pregnancy of cephalic presentation.

Question 6

What drugs for cervical ripening avoided with history of previous uterine scar?

Answer 6

• Propess and prostin

Question 7

What are the 3 ways of cervical ripening?

Answer 7

• Prostin
• Propess
• Cervical ripening balloon

Prostin and propess should be used with caution in patietns with history of glaucoma and asthma. It should also be used with caution in patients with diseases which could affect the metabolism or excretion of the medication e.g. lung, liver or renal disease.

Question 8

How is prostin used for cervical ripening?

Answer 8

3mg Prostin vaginal tablet is inserted into the posterior fornix of the vagina one day before the planned induction. Cervical assessment can be made either at the onset of regular contractions or in the next morning.

Question 9

How is propess vaginal pessary used for cervical ripening?
What are the indications for removal?

Answer 9

Question 10

How is mechanical cervical ripening done for cervical ripening?

Answer 10

Cervical ripening balloon is inserted at 12 hours before planned induction (usually 8pm). Balloon should be removed in the next morning or upon any indications such as leaking or antepartum haemorrhage.
If the balloon is accidentally dislodged, inform doctor for assessment. The doctor should check and document if the balloon is intact in the progress notes.

Question 11

What is the monitoring after propess/prostin insertion/cervical ripening balloon?
If cervix is favorable/unfavorable what is done?

Answer 11

Question 12

What are the 3 ways of medical induction?

Answer 12

• Syntocinin infusion
• PGE2 induction
• Misoprostol

Syntocinon infusion can be used for medical augmentation in case of slow progress during labor.
PGE2 induction will be used for cases with unfavorable cervix.
Misoprostol will be used for intrauterine death.

Question 13

How is syntocinin infusion done for medical induction?

Answer 13

Question 14

How is oxytocin titration method done for medical induction?

Answer 14

Question 15

How is PGE2 induction medical induction done?

Answer 15

Question 16

Who is indicated for medical induction by misoprostol?

Answer 16

Misoprostol should only be offered as a method of induction of labour to women who have intrauterine fetal death.