Induced Labour, Foetal Monitoring and Caesarean Sections

Question 1

What is an amniotomy?

Answer 1

Artificial rupture of the amniotic membrane

Question 2

What is the induction of labour?

Answer 2

Starting labour via the use of medications, can also include amniotomies

(IV oxytocin often given to induce uterine contractions)

Question 3

What are some indications for the induction of labour?

Answer 3

• Hypertensive disorders in pregnancy / other maternal medical conditions (eg. diabetes)
• Prolonged pregnancy
• Twin pregnancy
• Prelabour rupture of membranes
• Foetal growth restriction or macrosomia
• Maternal request
• Prebious stillbirth or in-utero death
• Post-dated uncomplicated pregnancy

Question 4

What are some contraindications for induction of pregnancy?

Answer 4

• Malpresentation
• Placenta praevia / vasa praevia
• Prolapsed umbilical cord
• Foetal distress
• Anatomical abnormalities (eg. pelvic tumour)
• Previous caesarean sections
• Maternal asthma

Question 5

What is the Bishops score?

Answer 5

Method of assessing the cervix for readiness for labour

A low Bishops score (<5) means labour is unlikely to start without induction

Question 6

What is the effect of misoprostol? How is it usually administered?

Answer 6

Encourage cervical dilatation and effacement

Usually given topical cream

Alternative is a balloon catheter

Question 7

What is given to initiate uterine contractions?

Answer 7

Syntocinon - synthetic oxytocin. Given via IV

Question 8

What are some possible complications of induction of labour?

Answer 8

Uterine hypertonicity 
Foetal distress
Adverse effects of drugs (hypotension / hyponatraemia)
Failed induction
Ruptured uterus

Question 9

How is foetal monitoring done?

Answer 9

Low risk labours - intermittent auscultation

Higher risk labours - cardiotocography (CTG)

Question 10

How is intermittent auscultation done? What does it measure? When is it done?

Answer 10

Done via doppler ultrasound

Measures foetal heart rate

It is done for one minute after a contraction every:

• 15 mins in the first stage of labour
• 5 mins in the second stage of labour

Question 11

If any abnormalities are detected on Intermittent auscultation what is done?

Answer 11

If abnormalities are detected switch to CTG

Question 12

What does a CTG measure?

Answer 12

• Fetal heart sensor measures the fetal heart rate

- Contraction motion sensor measures the contractions of the uterus

Question 13

What are some indications for CTG monitoring?

Answer 13

• Induction of labour
• Multiple pregnancy
• Post / pre maturity of the child
• Underlying maternal health conditions
• Antepartum or intrapartum haemorrhage
• Pyrexia
• Abnormal presentation / size for gestational age
• Epidural anaesthesia
• Abnormalities seen on intermittent auscultation

Question 14

What information needs to be interpreted from the results of the CTG?

Answer 14

Contractions - how many in 10 minutes

Heart:

• Rate (100-160 normal)
• Variability of rate
• Accelerations (up spikes)/ Decelerations (downward spikes - can be a sign of foetal distress)

Question 15

What can be done to confirm signs of foetal distress on CTG?

Answer 15

Foetal blood sampling

Small scratch made on the foetal scalp and the blood analyzed for pH
- Low pH (<7.2) = foetal hypoxia, need immediate delivery

Question 16

What can be a common complication of foetal hypoxia?

Answer 16

Foetal hypoxia is responsible for 10% of all cerebral palsy

Question 17

What is a caesarean section? How common are they?

Answer 17

Delivery of a foetus through an incision in the abdominal wall and uterus

32% of deliveries in Scotland are by C-Section

Question 18

What are the two types of caesarean section?

Answer 18

Lower uterine segment incision - horizontal cut through the lower abdomen, done in 99% of C-Sections

Classical - vertical cut through the abdomen near the level of the umbilicus, rarely done. Indicated if very premature foetus or rapid delivery required

Question 19

What are some of the indications for Caesarean Sections?

Answer 19

• Foetal distress
• Failure to progress in labour
• Failed induction of labour
• Malpresentation
• Severe pre eclampsia
• Placenta praevia
• Twin pregnancy with non-cephalic presenting twin
• Repeat caesarean section

Question 20

What are the four categories of caesarean section?

Answer 20

1. Emergency - immediate threat to life of the woman or the foetus
2. Urgent - Maternal or foetal compromise, but not immediately life threatening
3. Scheduled - requires early delivery but no compromise / time limit
4. Elective - At a time to suit the woman and maternity team (around half of C sections)

Question 21

What are some possible complications of c sections affecting the mother?

Answer 21

Injury to structures (iatrogenic)

DVT

Infection

(prophylactic antibiotics and LMWH usually given to prevent these complications)

Question 22

What are some long term risks of caesarean sections impacting future pregnancies?

Answer 22

• Increased risk of placenta praevia / accreta
• Increased risk of antepartum stillbirth
• Uterine rupture
• Post operative adhesions affecting future fertility