Labor Induction Lecture Powerpoint

Question 1

Elective induction of labor should only be done at ___ weeks gestation or later

Answer 1

39

Question 2

Gestational age of > or = to 39 weeks implied by the following criteria (3)

Answer 2

• ultrasound measurement at less than 20 weeks gestation that supports clinically determined gestational age equal to or greater than 39 weeks
• 36 weeks having elapsed since serum or urine hCG based pregnancy test was reported positive
• fetal heart tones have been documented for 30 weeks by doppler ultrasonogrphay
• last menstrual period doesn’t matter!!!

Question 3

Indications of labor induction (7)

Answer 3

• pre/eclampsia
• fetal demise
• abruption
• chorioamnionitis
• premature rupture of membranes
• post term pregnancy
• fetal compromise

Question 4

Contraindications to labor induction (4)

Answer 4

-vasa previa
-complete previa
-umbilical cord prolapse
-active genital herpes
(just move to c section for most of these)

Question 5

Urine pregnancy test becomes positive day __ after conception
Fetal doppler can hear fetal heart rate at ___ weeks
Earliest cardiac activity can be measured on ultrasound is ___weeks

Answer 5

10, 12, 6 weeks

Question 6

Principles of labor induction (2)

Answer 6

• ripen the cervix (bishop score of 6 or less is considered unfavorable and 8 or more is favorable same as spontaneous)
• start contractions

Question 7

Bishop score

Answer 7

Scoring system to determine likelihood of successful induction based on cervix dilation, effacement, etc with a score of 6 or less considered unfavorable and 8 or more very good

Question 8

Mechanical cervical dilators (3)

Answer 8

• laminaria (drug associated with increased peripartum infections)
• balloon catheters (low cost, stable at room temp)
• extra-amniotic saline infusion (30-40ml/hr)

Question 9

Nipple stimulation for labor induction

Answer 9

Old school technique where self stimulation of unilateral nipples helped increase uterine contraction

Question 10

Membrane stripping

Answer 10

Unpredictable technique that induces labor at some time after from 1 day to weeks later that is contraindicated in rupture of membranes and GBS infection that involves sweeping the cervix (sometimes causing bleeding) with finger manipulation

Question 11

Misoprostol (cytotec) for labor induction

Answer 11

Drug with No evidence of longterm neonatal harm but can be misused and cause complication such as tachysystole in labor induction, also used for peptic ulcer disease

Question 12

PGE2 for labor induction

Answer 12

Gel syringe kept refrigerated and inserted into vagina approved for cervical ripening, increases risk of tachysystole but generally considered safe to use

Question 13

Cervidil placement

Answer 13

Prostaglandin delivery insert placed on the cervix with variable time of inducing ripening as reaction before being withdrawn using withdrawal tape

Question 14

Methods of labor induction (4)

Answer 14

• oxytocin
• membrane stripping
• amniotomy (often when combined with oxytocin can produce delivery less than 24 hours but if can’t access cervix well then don’t do it)
• nipple stimulation

Question 15

Almost every obstetrical law suit involves the use of…

Answer 15

….oxytocin (start low and go slow!)

Question 16

Herbs used to promote induction of childbirth (3)

Answer 16

• evening primrose oil
• blue cohosh
• castor oil

Question 17

Prematurity rate in US has fallen directly correlating with…

Answer 17

….cessation of induction earlier than 39 weeks

Question 18

Elective induction of labor does NOT increase….

Answer 18

…c section rate or forceps rates