Induction + augmentation of labour

Question 1

Maternal indications for induction of labour

Answer 1

blood pressure problems (PIH, PET)
PROM (expectant management for 24h or IOL, GBS +ve offer IOL)
PPROM
maternal request (timing, PGP, MH)
intrauterine foetal death
previous c-section

Question 2

Foetal indications for induction of labour

Answer 2

prolonged pregnancy/post-dates
multiple pregnancy
reduced foetal movements
SFGA
maternal age >40y
diabetes (pre-existing 37-38+6/40, GDM by 40+6/40)
?LGA

Question 3

When is induction of labour not recommended?

Answer 3

breech
foetal growth restriction with a compromised foetus
contraindications to vaginal delivery (placenta praevia, previous sections)

Question 4

Benefit of induction of labour

Answer 4

reducing risk of harm to mother or baby

Question 5

Risks/complications of induction of labour

Answer 5

epidural
prolonged labour
uterine hyperstimulation
cord prolapse at time of amniotomy
uterine rupture
shoulder dystocia
PPH
unsuccessful induction

Question 6

What should be done in the assessment before induction of labour?

Answer 6

abdominally assess level and stability of foetal head
USS if concerns about position of baby
assessing and recording bishop score
confirm normal foetal heart rate pattern using CTG
confirm absence of significant uterine contractions

Question 7

What is a membrane sweep?

Answer 7

gently separating the membranes of the amniotic sac from the cervix during an internal examination This separation can stimulate the release of hormones that may help to start or progress labour

Question 8

What methods can be used to induce labour?

Answer 8

dinoprostone controlled release vaginal delivery system
dinoprostone tablet and gel
misoprostol tablets
balloon catheter
laminiara tents
dilapan

goal to open cervix enough to do ARM (artificial rupture of membranes)

if contractions then going, monitor progression
or oxytocin can be given to start contractions

Question 9

What is augmentation of labour?

Answer 9

medical process used to stimulate the uterus to increase the frequency, duration, and intensity of uterine contractions after the onset of spontaneous labour

commonly used to treat delayed labour when uterine contractions are insufficient

Question 10

When is labour delayed in a nulliparous woman?

Answer 10

active 1st stage >20 hours

Question 11

When is labour delayed in a multiparous woman?

Answer 11

active 1st stage >14 hours

Question 12

How much progress should a nulliparous and multiparous woman make i active 1st stage labour?

Answer 12

nulliparous = 2cm in 4 hours
(1cm in 2 hours)
multiparous = 4cm in 4 hours (1cm in 1 hour)

Question 13

Causes of delayed 1st stage of labour?

Answer 13

power:
- not frequent enough (ideally 4:10)
- not long enough (ideally 60s)
- not powerful enough

passage:
- prev pelvic fracture
- cervical stenosis
- vaginal septum
- FGM
- pelvic masses
- full bladder/rectum
- abnormal placental position
- Bandl’s ring
- fibroids

passenger:
- malpresentation
- hydrocephalus
- hydrops
- goitre
- cystic hygroma
- macrosomia
- malposition - OP, OT, asynclitism, deflexion

Question 14

Intervention in delayed active first stage of labour

Answer 14

support, hydration, pain relief
empty bladder
check presentation

amniotomy (ARM)
oxytocin - needs CTG, consider analgesia, increase rate to achieve 4:10, expect minimum 2cm progress in 4h, can also help with malposition

Question 15

Complications of augmentation of labour

Answer 15

infection
uterine hyperstimulation
atonic PPH
uterine rupture
instrumental deliveries
C-section
perineal trauma