12 Questions
What is the main purpose of the Bishop Score?
To predict the success of elective induction of labour
What is the maximum score in the Bishop Score system?
13
What is the term for the process of stimulating the uterus to increase the frequency, duration, and intensity of contractions during labour?
Augmentation of labour
What is the definition of uterine tachysystole?
5 or more contractions in 10 minutes
What is the purpose of cervical ripening?
To prepare the cervix for labour
What is the likely mechanism by which nipple stimulation stimulates uterine contractions?
Increased oxytocin levels
What is the purpose of using osmotic dilators in obstetrics?
To soften the cervix by absorbing water and causing dilation
When would an intra-cervical balloon be inserted during pregnancy?
To induce labor by applying pressure on the cervix
What is the procedure known as membrane stripping/sweeping aimed to do?
To release prostaglandins and shorten pregnancies
When is amniotomy typically performed during labor induction?
When the cervix is not ready for induction
Which condition would be a contraindication for the use of osmotic dilators in obstetrics?
Vasa previa
What is the primary concern associated with intra-amniotic saline infusion during labor induction?
Haemorrhage from uncontrolled uterine bleeding
Study Notes
Induction of Labour
- Bishop Score: a 13-point scoring system to predict the success of induction of labour (IOL)
- The score assesses cervical dilation, effacement, station, cervical position, and consistency
- Scoring:
- Cervical dilation: 0-3
- Effacement: 0-3
- Station: -3 to +3 (0-3)
- Position: 0-2
- Consistency: 0-2
- Score of 8 or more: favourable for IOL
- Score of 6 or less: unfavourable for IOL
Induction of Labour (IOL)
- Definition: chemical or mechanical initiation of uterine contractions before spontaneous onset of labour
- Purpose: to bring about birth
Augmentation of Labour
- Definition: stimulating the uterus to increase frequency, duration, and intensity of contractions after spontaneous labour onset
- Purpose: to enhance existing contractions
Uterine Tachysystole
- Definition: 5 or more contractions in 10 minutes, averaged over a 30-minute window
- Applies to spontaneous and stimulated labour
Cervical Ripening
- Definition: softening of the cervix prior to spontaneous labour
- Process: connective tissue components of the cervix are remodelled extensively before contractions begin
Nipple Stimulation
- Definition: breast stimulation to stimulate uterine contractions, likely by increasing oxytocin levels
Osmotic Dilators
- Definition: seaweed or synthetic compounds that absorb water, causing the cervix to dilate
- Examples: seaweed, synthetic compounds
Indications for IOL
- Diabetes
- Hypertensive disorders
- Chorioamnionitis
- Post-term pregnancies (42 weeks gestation)
- Oligohydramnios
- IUGR
- Isoimmunisation
- Prolonged PROM
- Pre-eclampsia
- IUFD
- TOP
Contraindications for IOL
- Vasa previa
- Placenta previa (major)
- Fetal distress
- Myomectomy with entry into uterine cavity
- Previous classical c/s
- Active genital herpes outbreak
- Umbilical cord prolapse
- Face presentation
- Grand multiparity
- Breech presentation
- Inability to monitor FHR throughout labour
- Transverse fetal lie
- Floating fetal presenting part
- Uncontrolled haemorrhage
- Large fetus (>4.5kg or >4kg in diabetic mothers)
- Breech (must be a complete one)
Extra-Amniotic Saline Infusion
- Definition: infusion of saline into the space between the uterine wall and chorion to release prostaglandins
- Indication: urgent IOL or catheter expulsion has not occurred after 4-6 hours
- Procedure: infuse 200ml saline bolus at room temperature via intra-cervical catheter
- Rate: 40-50ml/hr
- Maximum: 2 litres
Intra-Cervical Balloon
- Definition: aseptic procedure to induce labour
- Procedure: insert catheter through cervical canal, inflate, and place on traction
- Position: just above internal os, applying pressure
- Review cervix after expulsion for further management
- Remove catheter if not expelled by 24 hours
Membrane Stripping/Sweeping
- Definition: method to induce labour by releasing prostaglandins
- Procedure: separate chorion from cervix and lower uterine segment using finger insertion and rotation
- More effective in primigravidas
- Associated with:
- Shorter pregnancies
- Decreased need for chemical or mechanical inductions
- Increased risk of infection, rupture of membranes, bleeding, and precipitated labour
- No evidence of improved maternal or fetal outcomes
Amniotomy (AROM)
- Definition: artificial rupture of membranes to induce or augment labour
- Indication: ripe cervix
- Procedure: rupture membranes vaginally using an amnihook
Test your knowledge on the Bishop Score, a 13-point scoring system used to assess the readiness of a pregnant woman's cervix for induction of labour. Learn about the criteria such as cervical dilation, effacement, station, position, and consistency that are taken into consideration before the procedure.
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