Induction and Augmentation of Labour

Question 1

What is induction of labour cf augmentation?

Answer 1

The process of causing labour to commence (and continue); augmentation is the process of stimulating a labour already commenced

Question 2

What must be considered in deciding to induce labour?

Answer 2

The risks of continuing the pregnancy cf those of interrupting the pregnancy

Question 3

What are the reasons to induce labour?

Answer 3

• Post maturity: EDD +10d
• HTN /PEt
• DM
• ROM / chorioamnionitis
• IUGR
• Foetal compromise
• Blood group isoimmunisation
• Abruption
• Twin pregnancy
• FDIU
• TOP
• Social

Question 4

What are reasons not to IOL?

Answer 4

• Prematurity
• IUGR*
• Foetal compromise *
• Breech / transverse lie
• Praevia
• Previous LUSCS
• Cephalopelvic disproportion
• may be better delivered via LUSCS

Question 5

What are the methods to induce labour?

Answer 5

1. Prostin E2
2. ARM
3. Syntocinon
   May require 1, 2 or all to achieve IOL

Question 6

What is the role of pristine?

Answer 6

Prostaglandin E2 used to ripen the cervix: soften and partially dilate to allow ARM

Question 7

What are the risks of prostin?

Answer 7

May cause uterine hyper stimulation with:

• foetal distress
• precipitate labour
• uterine rupture

Question 8

When should prostin be avoided?

Answer 8

• Previous uterine scar

- Ruptured membranes

Question 9

What is required during prostin administration?

Answer 9

CTG monitoring before and after administration

Question 10

What is ARM?

Answer 10

Small hook or forcep used to rupture the forewaters

Question 11

What must be considered when performing ARM?

Answer 11

Bewared cord prolapse if presenting part not well applied

Question 12

What is syntocinon?

Answer 12

Posterior pituitary polypeptide which stimulated uterine muscle contraction

Question 13

Risks of syntocinon?

Answer 13

- Uterine hyper stimulation with foetal distress (need CTG)
Side effects:
- Nausea
- Vomiting
- Water intoxication
- Hyponatremia

Question 14

What are the complications of IOL?

Answer 14

• Cord prolapse (poorly applied presenting part)
• Uterine hyperstimulation (rupture, precipitate delivery) with PE2 or syntocinon
• Foetal distress
• Process may fail

Question 15

What is the role of instrumental delivery?

Answer 15

Facilitate or expedite vaginal delivery

• Foreceps
• Ventouse Vacuum

Question 16

When should instrumental delivery be considered?

Answer 16

1. Delay in 2nd stage of labour:
   - maternal exhaustion
   - effective epidural
   - malposition of presenting part
2. Foetal distress in second stage necessitating expedition of delivery

Question 17

What is appropriate analgesia for an instrumental delivery?

Answer 17

• Epidural
• Spinal
• GA
• Pudendal block with perineal infiltration of local

Question 18

What is required for an instrumental delivery?

Answer 18

• Experience with instrument
• Cervix fully dilated
• Foetal head engage
• Cephalic
• Analgesia
• Lithotomy
• Catheter (bladder empty)
• Resuscitation for baby
• May need episiotomy

Question 19

What is the role of Neville Barnes forceps?

Answer 19

For anterior positions of foetal head

Question 20

What are Keilland’s forceps used for?

Answer 20

To rotate the posterior position head to an anterior position; then apply NB forceps for delivery from anterior position

Question 21

What may the ventouse vacuum be used for?

Answer 21

Delivery from anterior position; or to rotate to anterior with subsequent delivery

Question 22

What are the complications of forceps delivery?

Answer 22

Excessive force or incorrect application may cause:

• bruising
• facial nerve palsy
• damage to C spine
• intracerebral bleed

Question 23

What are the complications of Ventouse?

Answer 23

• Temporary chignon
• Circular bruise
  May cause:
• Subaponeurotic bleeding
• Intracerebral bleeding

Question 24

What are the maternal complications of instrumental delivery?

Answer 24

Soft tissue tears and bruising to vagina and perineum