Labor Induction Practices and Considerations

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Questions and Answers

What factors should be considered when determining the timing for induction of labor in women with uncomplicated singleton pregnancies?

Women's preferences and risk factors (correct)

Previous births and local hospital protocols

Family medical history and fetal size

Current maternal weight and age

Which woman is most likely to be advised to consider induction of labor from 39 weeks?

A 40-year-old woman with a BMI of 20 kg/m2

A 35-year-old woman with no previous complications

A 37-year-old woman with a BMI of 30 kg/m2 (correct)

A 28-year-old woman with a BMI of 25 kg/m2

Why is increased fetal monitoring recommended for women who opt not to have their labor induced?

To provide reassurance that the baby is not in distress (correct)

To assess the need for immediate cesarean delivery

To identify risks that can be managed with interventions

To ensure spontaneous labor occurs on time

What is a limitation of monitoring fetal well-being during pregnancy?

It may not detect all possible fetal complications Signup and view all the answers

What must healthcare providers do if a woman chooses not to have her labor induced?

Provide support for her decision, including her choice of place of birth Signup and view all the answers

What should be done if the fetal heart rate is abnormal during labor induction?

Remove any vaginal pessaries and reassess the situation. Signup and view all the answers

What is the primary purpose of membrane sweeping?

To reduce the likelihood of requiring induction of labor. Signup and view all the answers

Which of the following is not supported as an effective method for induction of labor?

Prostaglandins Signup and view all the answers

What is the typical method of administering prostaglandins during labor induction?

Vaginally, typically in the posterior fornix. Signup and view all the answers

Which statement regarding the use of Propess is accurate?

Bed rest is required for 30 minutes after administration. Signup and view all the answers

Before performing a membrane sweep, what is a crucial step?

Obtain the woman's consent. Signup and view all the answers

Which of the following conditions indicates the use of prostaglandins for labor induction?

Unfavorable cervix with a Bishop score ≤ 6. Signup and view all the answers

What is a potential side effect of membrane sweeping?

Vaginal bleeding may occur. Signup and view all the answers

What should be monitored when regular, painful contractions have been established?

Uterine activity and fetal movements Signup and view all the answers

What is a potential side effect of Prostaglandin E2 (PGE2)?

Nausea and vomiting Signup and view all the answers

What is the purpose of performing an abdominal examination before amniotomy?

To check for cord prolapse Signup and view all the answers

How often should observations be performed for a woman with no contractions after receiving PGE2?

Every four hours Signup and view all the answers

What is one risk associated with the use of PGE2?

Uterine rupture Signup and view all the answers

When should Oxytocin be considered for multiparous women after ARM?

After 2 hours Signup and view all the answers

What should be done immediately after an artificial rupture of membranes (ARM)?

Assess fetal heart rate for one full minute Signup and view all the answers

Which of the following is NOT a risk associated with amniotomy?

Transient increase in maternal pulse Signup and view all the answers

What should be monitored in a woman with prelabour rupture of membranes at term?

Changes in general wellbeing Signup and view all the answers

Which option is NOT recommended for a woman with prelabour rupture of membranes at term?

Complete bed rest without monitoring Signup and view all the answers

In which circumstance can oxytocin be commenced immediately after artificial rupture of membranes (ARM) in nulliparous women?

When the BISHOP score is less than 7 Signup and view all the answers

What is a significant risk for women who have had a previous lower segment caesarean birth when considering induction of labor?

Increased risk of uterine rupture Signup and view all the answers

What is a noted risk associated with the prolonged use of oxytocin during labor?

Increased need for epidural analgesia Signup and view all the answers

What is the recommended primary method for induction of labor (IOL) when PGE2 is contraindicated?

Combination of oxytocin and ARM Signup and view all the answers

What immediate action should be taken if a woman with prelabour rupture of membranes has a positive group B streptococcus test?

Offer immediate induction of labor or caesarean birth Signup and view all the answers

When offering care options to a woman with prelabour rupture of membranes, which statement is true?

She should be supported in her decision on how to proceed. Signup and view all the answers

How is oxytocin commonly administered during labor?

IV, diluted with Normal Saline Signup and view all the answers

Which medication is contraindicated in women with a uterine scar?

Dinoprostone Signup and view all the answers

What should women do first when contractions begin?

Contact their obstetrician/midwife Signup and view all the answers

What should be monitored in patients with prelabor rupture of membranes at term?

Fetal heart rate and vital signs Signup and view all the answers

What is a major contraindication for the use of oxytocin as the sole method for induction of labor?

High BISHOP score Signup and view all the answers

What type of examination is performed to assess the growth and position of the fetus in cases of prelabour rupture of membranes?

Abdominal examination Signup and view all the answers

What is the recommended gestational age for inducing labor in women with uncomplicated singleton pregnancies?

41 weeks Signup and view all the answers

Which of the following describes a method for accelerating labor?

Amniotomy and syntocinon Signup and view all the answers

What is the recommended monitoring for a woman who chooses induced labor after intrauterine fetal death?

Continuous monitoring of uterine contractions Signup and view all the answers

Which of the following is NOT one of the roles of a midwife during labor?

Providing anesthesia Signup and view all the answers

What percentage of women are expected to give birth by 42 weeks gestation without induction of labor?

82% Signup and view all the answers

Which potential complication is NOT associated with the use of oxytocin during labor?

Knee ligament injury Signup and view all the answers

What should be done if a woman chooses not to have induced labor?

Her care options should be discussed and supported Signup and view all the answers

What is a concerning sign for women during labor that should prompt them to contact their health care provider?

Reduced fetal movements Signup and view all the answers

Which of the following is true regarding the incidence of stillbirth and gestation?

It increases with extended gestation Signup and view all the answers

What common concern might prompt a woman to contact her healthcare provider during labor?

Loss of the pessary Signup and view all the answers

Study Notes

Induction of Labour (Prolonged Pregnancy, Prelabour Rupture of Membranes at Term)

Induction of labour is the artificial initiation of labour before spontaneous onset.
It can be viewed as any procedure or intervention that starts labour rather than letting it begin naturally.
Key factors influencing choice of induction include the woman's circumstances, preferences, and identified risk factors (NICE 2008, updated 2021).
Induction indications include prolonged or post-term pregnancy, medical problems (e.g., diabetes, hypertension), poor obstetric history, prelabor rupture of membranes for more than 24 hours, maternal request (after discussion of risks/benefits), advanced maternal age and suspected fetal compromise.
Fetal compromise indications include suspected IUGR, reduced fetal movement, macrosomia, Rh isoimmunization, severe congenital abnormalities, and fetal death.
Induction should be offered with caution in specific situations like previous C-sections (with classical incisions), high parity, polyhydramnios, or uncertain due dates.
Multiple pregnancies, macrosomia (absence of diabetes), history of precipitate labour are amongst the insufficient reasons for induction which should not be routinely offered, according to evidence.
Contraindicated cases include placenta praevia or vasa praevia, oblique or transverse lie, malpresentation (breech), cord presentation/prolapse, and severe fetal compromise.
Procedures for assessing before induction include abdominal assessment of fetal head position, recording the Bishop score, confirming normal fetal heart rate and absence of uterine contractions(NICE 2008 amended 2021) ensuring facilities for cardiotocography are available.
The Modified Bishop score is a method used to evaluate the cervix's favourability for induction. It considers factors like dilation, cervix length, station of the presenting part, consistency of the cervix, and the position of the cervix.
Membrane sweeping is a technique that might increase the chances of labour starting naturally.
It can be offered routinely at gestational age 39+0 weeks.
Alternative methods (herbal supplements, acupuncture, homeopathy, castor oil, hot baths, enemas sexual intercourse) are not supported by evidence.
Medical methods for induction, such as prostaglandins (PGE2), are locally acting chemical compounds, commonly administered vaginally, and help ripen the cervix and contribute to uterine contractions. Labour results in 30-50% of cases.
Prostaglandins can cause side effects such as nausea, vomiting, diarrhea, uterine hyperstimulation, placental abruption, fetal hypoxia, and uterine rupture (which are rare 0.3-7%).
Post-induction care involves continuous monitoring of maternal and fetal wellbeing (including fetal heart rate, uterine contractions, and vaginal loss) (NICE 2008, updated 2021).
There are different protocols for removing the prostaglandins based on whether the contractions have started or if there is fetal distress (NICE 2008 updated 2021).

Amniotomy

Amniotomy (ARM) is the artificial rupture of the membranes.
It is indicated when the cervix is favourable or to accelerate/augment labour.
Assessing cervix, presentation and station before amniotomy is critical.
Risks of amniotomy include infection, early deceleration, cord prolapse, and bleeding.
Post ARM, procedures for monitoring include assessing fetal heart rate, documentation of liquor colour/consistency, encouragement of uterine mobility and whether to consider giving oxytocin.
Oxytocin is a powerful uterotonic agent, often used to augment or maintain labour.
It is usually administered intravenously after cervical ripening and ruptured membranes.
It can lead to uterine hyperstimulation, fetal hypoxia, fluid retention, uterine rupture, and amniotic fluid embolism.

Induction or Augmentation of Labour after previous lower segment cesarean birth and IOL after Intrauterine Fetal Death (IUFD):

Risk of uterine rupture is higher in women with previous lower segment caesarean births or IUFD who are being induced and should be considered in the care plan, and contraindications/warnings should be assessed carefully.

IOL for Post-Term/Prelabour Rupture of Membranes (PROM)

Induction is recommended for those with gestational age of 41 weeks. (NICE 2021)
If not at 41 weeks, consider the woman's decision, and provide support with the chosen method (NICE 2021).
The risk of stillbirth increases with gestational age beyond 41+0 weeks (a known risk factor)
For pre-labour rupture of membranes, offer choice of induction or expectant management for 24 hours, offer IOL after 24 hours (NICE 2008 updated 2021).

Outpatient Induction

Outpatient methods and preparations for inducing labour should be considered in cases without significant medical or obstetric complications. (NICE 2008, amended 2021).

Role of Midwife

Planning stage includes good communication and obtaining informed consent.
In labour, midwives monitor maternal and fetal wellbeing, assess progress and keep accurate records.

NICE Guideline Summary

Updated NICE guidelines, recommend induction at 41 weeks and support a woman's decision if they choose not to be induced and discuss care options.

Summary Overview

Healthcare professionals should thoroughly discuss potential risks and benefits of induction of labour with expectant mothers considering her circumstances and choices.

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Description

This quiz explores key factors involved in the induction of labor for women with uncomplicated singleton pregnancies. Questions cover timing, methods, monitoring, and the roles of healthcare providers. It is essential for understanding best practices in obstetric care.