Induction of labour

Question 1

What 3 things are used for cervical ripening?

Answer 1

• Prostin
• Cervidil
• Balloon Catheters

Question 2

When is an IOL usually recommended for ‘prolonged pregnancy’?

Answer 2

41+0 - 42+0

Question 3

When is an IOL recommended for PROM (at term) for GBS neg/unknown

Answer 3

Within 24hrs

Question 4

When is IOL recommended for GBS+, mec liquor and suspected sepsis?

Answer 4

Immediately.

Question 5

What is the risk of IOL with someone who has had a previous C/S?

Answer 5

Increased risk of uterine rupture and emergency C/S

Question 6

Is an IOL recommended for suspected fetal macrosomnia?

Answer 6

NO.

Question 7

For a woman with a BMI >50 delivery is recommended at …….

Answer 7

38-39 weeks. Due to the presence of co-morbidities.

Question 8

What method of IOL is recommended for someone with a risk of uterine scar rupture?

Answer 8

Balloon catheter, rather than prostaglandins or oxytocin.

Question 9

Is AMA a reason for or against having an IOL?

Answer 9

Against. There is an increased risk of perinatal mortality in women over 35yrs.

Question 10

What are some reasons for IOL?

Answer 10

• abnormal CTG or USS
• Fetal growth restriction
• decreases fetal movements
• APH
• FDIU
• HTN
• GDM
• hx of stillbirth
• maternal health reasons

Question 11

When is IOL contraindicated?

Answer 11

• malpresentation
• previous C/S
• cord presentation
• placenta praevia or vasa praevia
• primary genital herpes
• cervical carcinoma

Question 12

What does the Bishop score need to be for Prostin to be used?

Answer 12

<5

Question 13

TRUE/FALSE: ARM, oxytocin can be commenced after Prostin.

Answer 13

FALSE. Need to wait 6hrs for oxytocin and 4hrs for ARM.

Question 14

What is the 3rd stage management for IOLs started with Prostin?

Answer 14

Active.

Question 15

Where is Prostin inserted?

Answer 15

posterior fornix of vagina. Not in cervical canal!

Question 16

Can Dinoprostone (Cervidil) be inserted into the cervical canal?

Answer 16

No. High into the posterior vaginal fornix with a small amount of lubricant.

Question 17

When does Cervidil tape need to be removed?

Answer 17

• SROM
• regular painful contractions every 3 mins
• ADR - N&V, hypotension or tachycardia
• 30min prior to IV oxytocin
• if ripening has not been sufficient within 24hrs

Question 18

Why can balloon catheters be the preferable treatment for cervical ripening?

Answer 18

Reduced rates of uterine hyperstimulation and tachysystole, reduced rates of instrumental birth due to fetal distress and fewer neonatal intensive care admissions.

Question 19

How much water should be inserted into the Foley catheter?

Answer 19

30ml

Question 20

When should the Foley catheter be removed?

Answer 20

12-24hrs post insertion

• SROM
• onset of labour
• hyperstimulation or fetal distress

Question 21

What is the brand name of oxytocin used for IOL?

Answer 21

Syntocinon.

Question 22

What are the precautions for Syntocinon use?

Answer 22

• Bishop score <6
• Previous C/S
• within 6hrs of Prostin
• Within 30mins of Cervidil removal
• Multiparous women, particularly when epidural or other analgesia is used

Question 23

How is the fetus to be monitored if Syntocinon is being used for augmented labour?

Answer 23

Continuous CTG.

Question 24

What is the doses for standard Syntocinon during labour?

Answer 24

Begin with 12ml/hr up to 192ml/hr. Going up by 12ml/hr every 30min.
Starts 2miliunits/min going up by 2 every 30mins.

Question 25

What needs to be aimed for in regards to contractions during Syntocinon use?

Answer 25

4:10 strong contractions with 60 seconds of resting tone.

Question 26

What method of IOL is mostly used in the case of fetal death or termination?

Answer 26

Misoprostol

Question 27

What should be done prior to an IOL?

Answer 27

Vital signs, check vaginal loss, abdominal palpation, CTG, uterine activity and a VE for a Bishop score.

Question 28

How often should contractions be palpated during Syntocinon induction?

Answer 28

Every 30mins for 10mins.