Induction and augmentation

Question 1

what is augmentation of labour

Answer 1

speeidng up labour that is already established if not progressing, usually using oxytocin infusion

eg waters broken but no contractions

Question 2

when is augmentation of labour indicated in the active phase of the 1stage

Answer 2

when cervical dilatation is not increasing by 0.5cm/hr in PG and 1cm/hr in MG

Question 3

what can be done a few days before IOL to increase likelihood of success

Answer 3

membrane sweep - causes release of PG

Question 4

what is the Bishop score

Answer 4

assess how the cervix will respond to IOL

Question 5

how are al the measurements for Bishop score taken

Answer 5

on vaginal examination

Question 6

what are the cut offs for Bishop score for a likely good response and bad response to IOL

Answer 6

<4 - not likely to progress naturally

>6 - likely to respond to interventions to induce labour

Question 7

what is the first step in IOL

Answer 7

vaginal prostaglandins - these ‘ripen’ the cervix by softening the collagen fibres

Question 8

when do you move onto the 2nd step of IOL

Answer 8

repeated vaginal PG application until the Bishop score is >6

Question 9

where are the PG inserted

Answer 9

into the posterior fornix

Question 10

2nd step of IOL

Answer 10

amniotomy - artificial rupture of membranes using a stick with a pointed hook on the end

Question 11

do you need to use vaginal PG before amniotomy

Answer 11

no you can go straight to amniotomy if cervix is ripe enough on first examination (Bishop score)

Question 12

what complications can arise from amniotomy

Answer 12

• bleeding
• failure
• placental abruption
• amniotic fluid embolism - pulmonary embolism = shock, dyspnoea, bleeding

Question 13

3 rd step in IOL

Answer 13

IV oxytocin infusion - start lower and increase until uterus is contracting regularly around 4 times/10 minutes

Question 14

what is syntometrine

Answer 14

oxytocin and ergometrine, the latter is also an arterial vasoconstrictor, this raises blood pressure so is CI in patients with PVD, hypertension, heart disease

Question 15

how many contractions in 10 mins is hyperstimulation

Answer 15

>5

Question 16

what are the dangers of foetal hyperstimulation

Answer 16

• as normal contractions cause transient foetal hypoxia, too many/strong results in foetal hypoxia –> CTG and FBS if indicated

Question 17

what is another complciation associated with oxytocin infusion

Answer 17

rupture of uterus - more likely if PG, previous C section

Question 18

what are 3 options if IOL fails

Answer 18

• Repeat vaginal prostaglandins
• Mechanical dilatation
• C section

Question 19

what is the main cause for IOL

Answer 19

post term gestation - after 42 weeks the risk of plcaenetal insufficinecy and stillbirth greatly increases

Question 20

diabetes and IOL

Answer 20

baby is at risk of stilllbith and neonatal hypoglycaemia, this risk increases more beyond term

IOL may be indicated around 38 weeks if mother has poor glycaemic control or there is evidence of macrosomia

Question 21

maternal age and IOL

Answer 21

increased risk of stillbirth >40 weeks

Question 22

reduced foetal movements and IOL

Answer 22

can be a sign of placenetal insufficinecy etc

Question 23

multiple pregnancy and IOL

Answer 23

DCDA want to deliver by 38 weeks and MCDA by 36 weeks (+ steroids) because there is a higher rate of still birth

Question 24

rupture of membranes and IOL

Answer 24

there is a risk of ascending infection

if baby is v premature (34 weeks) leave it for a bit (prematurity risk>infection)

if >37 weeks - IOL (infection risk>prematurity)