induction of labour

Question 1

urgent indiciaations for IOL

Answer 1

severe pre-eclampsia/HELLP syndrome
chorioamnionitis
confirmed foetal compromise of IUGR
- abnormal CTG
- abnormal dopplers
prolonged ruptured membranes

Question 2

priority indications for IOL

Answer 2

oligohydramnios
diabetes
gestational hypertension
cholestasis
fetal demise
rhesus isoimunicaation

Question 3

non urgent indications for IOL

Answer 3

gestation over 41 weeks + 3
confirmed macrosomia
uncomplicated twins

Question 4

stages of IOL

Answer 4

cervical ripening
artificial rupture of membranes
stimulate contractions

Question 5

cervical ripening

Answer 5

natural - stretch and sweep
hromonal - prostaglandins, prostin gel, misopristol
mechanical - transcervical catheter, osmotic dilator

Question 6

modified bishop score

Answer 6

Question 7

prostaglandins

Answer 7

pharmacological methods when bishop score <8
PG E2 gel: 1-2 mg doses
cervidil: 10mg controlled release pessary

Question 8

transervical catheter

Answer 8

non-pharmacological method
saline filled balloon - pressure to the lower uterus and cervix resulting in local production of prostaglandins and cervical ripening

Question 9

complications of oxytocin

Answer 9

delaayed breast milk production
uterine hyperstimulation
hyponatraemia
hypotension

Question 10

complicaations of IOL

Answer 10

hyperstimulation of the uterus
uterine rupture (if pt had a previous c-section)
fetal immaturity
umbilical cord prolapse following ARM

Question 11

contraindications for IOL

Answer 11

placenta praevia, vasa praevia, malpresentation
known cephalopod-pelvic disproportion
acute foetal compromise
cord presentation or prolapse

maternal - active herpes, HIV positive, maaternal refusal

Question 12

things to consider before starting IOL

Answer 12

review patient history and pregnancy
confirm gestational age
any contraindications for IOL
abdominal palpation
CTG and monitoring
VE
bishop score