Induction of labour

Question 1

What are the maternal indications for induction of labour?

Answer 1

1- medical disease (DM, HTN)
2- deteriorating medical illness
3- PROM
4- prolonged pregnancy
5- intrahepatic cholestasis
6- social reason
7- unexplained APH

Question 2

What are the fetal indications for induction of labour?

Answer 2

1- fetal growth restriction
2- twin pregnancy > 38weeks
3- fetal macrosomia
4- maternal isoimmunization
5- congenital malformation
6- oligohydramnios

Question 3

What are the contraindications for induction of labour?

Answer 3

1- placenta previa
2- FGR with fetal compromise
3- malpresentation
4- previous scarred uterus
5- severe hydrocephalus
6- significant macrosomia (5kg)

Question 4

What are the factors that increase success of induction?

Answer 4

• young age
• multiparity
• favorable cervix
• BMI < 30
• birth weight < 3.5kg

Question 5

What is used to know if the cervix is favorable for induction of labour?

Answer 5

BISHOP score
- score > 8: cervix is ready to dilate
- score < 6: unfavorable

Question 6

What are the methods of labour induction?

Answer 6

Pharmacological
- PGE2 (Dinoprostone): vaginal gel, time release vaginal insert -> cervical ripening before induction
- PGE1 (Misoprostol): tablet 100-200 microgram absorbed from buccal, vaginal, or oral routes -> cervical ripening & induction
- Oxytocin: IV infusion, increments added every 30 mins till contractions of 3-5 per 10 mins are acheived

Mechanical
- membrane sweeping: offered in ANC after 39 weeks, longer time for labour to start: safer than pharmacological
- foley catheter
- lamnaria

Question 7

What method of induction will be used depending on BISHOP score?

Answer 7

Score is 6 or less
- Dinoprostone (PGE2): gel, vaginal delivery system
- Misoprostol (PGE1): oral low dose 25 microgram vaginal

Score > 6
- amniotomy + oxytocin infusion

Question 8

What are the complications associated with use of misoprostol?

Answer 8

increased risk of tachysystole -> if contractions are >5 every 10 mins then
- stop induction
- give tocolytic (subcutaneous terbutaline)
- remove the insert

increased risk of rupture in cases with previous C section

Question 9

What are the complications of induction?

Answer 9

• failure
• PPH due to uterine atony
• uterine hyperstimulation
• cord prolapse (if amniotomy was done while head is too high)
• higher rate of instrumental delivery
• fetal compromise
• uterine rupture in cases with previous CS
• chorioamntionitis

Question 10

When does induction failure occur?

Answer 10

• cervix < 3cm after ARM & oxytocin infusion for 6-8hrs + regular contractions
• patient received prostaglandin max & no cervical change

Question 11

What are the options after failed induction?

Answer 11

• induction after rest period
• C section