induction of labour

Question 1

indications

Answer 1

prolonged pregnancy (>41w), hypertensive disorders, IUGR, diabetes, prelabour/prolonged rupture of membranes, rhesus disease, prev stillbirth, abruption, placental insufficiency

Question 2

contraindications

Answer 2

cephalopelvic disproportion, malpresentation (other than breech/face), fetal distress, placenta praevia, vasa praevia, cord presentation, pelvic tumour, cord presentation, prev repair to cervix

Question 3

what score on bishops score is ripe (cervical ripeness)

Answer 3

> 5

Question 4

what happens if a primip is induced and is not ripe (

Answer 4

higher rates fetal distress, C section, prolonged labour

Question 5

what can be used to ripen the cervix

Answer 5

prostaglandins (PGE2) - dinoprostone

Question 6

if the cervix fails to ripen with prostaglandins what should be done

Answer 6

repeat 6-8hours later and if still fails to ripen do a C section

Question 7

what may prostaglandins do apart from ripening cervix

Answer 7

uterine contractions, precipitate labour

Question 8

what happens after the cervix is ripe

Answer 8

rupture the membranes, amniotomy.

Question 9

what drug is used after cervix is ripe

Answer 9

oxytocin IV - syntocinon

Question 10

when should you stop inducing

Answer 10

in distress or uterine hyperstimulation

Question 11

what other drug can be used for cervical ripening and inducing labour

Answer 11

misoprostol- prostaglandin E1 analogue

Question 12

problems of induction

Answer 12

failed induction, uterine hyperstimulation, instrumental and C section rates higher, iatrogenic prematurity, infection, bleeding, cord prolapse, uterine rupture