Induction Of Labor

Question 1

How many women are induced in the UK

Answer 1

20%

Question 2

When to do IOL in low risk pregnanacies

Answer 2

41-42 w

Question 3

How many induced women do CS

Answer 3

<2/3 without intervention
22% CS
15% OVD

Question 4

Preganncy beyond 41 w may cause?

Answer 4

Increase risk of:
- stillbirth and neonatal death
- baby needing NICU
- CS

Question 5

If women chooeses not to have iol?

Answer 5

Discuss expectant or CS

Question 6

Fetal monitoring after 42 weeks

Answer 6

CTG twice weekly
U/S estimation of DVP

(Monitoring reflects current situation and doesn’t predict any adverse effects on baby as stillbirth)

Question 7

IOL effect on pregestatiional DM on insulin

Answer 7

Dec stillbirth and shoulder dystocia

Question 8

DM when indicates for elective CS

Answer 8

Macrosomic baby >4.5 kg

Question 9

What you avoid in case of symphysis pubis dysfunction in labor

Answer 9

Excessive leg separation
Epidural and spinal analgesia

Question 10

Bed rest after delivery of women with symphysis pubis dysfunction

Answer 10

24-48 hrs + stockings+ heparin ( to prevent dvt)

Question 11

Recurrence of symphysis pubis dysfunction in future pregnancies

Answer 11

70-85%

Question 12

34-37 w PROM + GBS +ve, when to start IOL

Answer 12

Immediate IOL or CS

Question 13

If ROM at term, when to start IOL

Answer 13

You have 2 options:
1. IOL now
2. Wait 24 hrs if no contractions: IOL

Question 14

Methods of inductions contraindicated in previous uterine scar

Answer 14

Misoprostol
Dinoprostone

Better use mechanical methods

Question 15

Maternal request to IOL

Answer 15

Not before 39 w

Question 16

Do we induce labor in breech

Answer 16

Not generally recommended

Only if ECV wasn’t successful and Planned CS is declined

Question 17

Do we induce labor in SGA

Answer 17

No if there is fGR W/ fetal compromise-> CS INSTEAD

Question 18

IOL in women w/ history of precipitate labor

Answer 18

Nope to avoid birth unattended by healthcare professionals

Question 19

IOL in bishop 7-10

Answer 19

Amniotomy + IV oxytocin infusion

Question 20

IOL in bishop 0-6

Answer 20

• Dinoprostone ( vag tablet, gel, pessary)
• low dose 25 mcg oral misoprostole
• if pharmaceutical not suitable or at risk of hyper stimulation -> consider mechanical methods ( balloon catheter - osmotic dilators)

Question 21

Membrane sweeping

Answer 21

Enter finger to the cx to separate membranes from the decidua

Question 22

When to discuss performing membrane sweeping

Answer 22

After 39 w

Question 23

Dose of dinoprostone PGE2 in IOL

Answer 23

Tablet or gel: one dose then another after 6 hours
Pessary: one dose over 24 hr

All applied to posterior fornix

Question 24

Preparation for IOL

Answer 24

1. Record bishop score
2. Antenatal CTG
3. Confirm absence of significant uterine contractions by CTG

Question 25

When ut. Contractions after dinoprostone or misoprostol

Answer 25

Start CTG CTG normal: IA CTG abnormal: continue ctg+ don’t give any more doses and remove pessaries

Question 26

when to do IOL in DM

Answer 26

GDM: 40+6 Typr I or II: 37-38+6

Question 27

PPROM DELIVERY TARGET AGE

Answer 27

37w