QuestionSBA
QuestionChoice
An artificial rupture of membranes (ARM) can only be performed where the cervix is favourable, the foetus is well engaged, and there is space to access the cervical os.
49896
e
Artificial rupture of membranes
QuestionChoice
Intravenous oxytocin is not used alone for induction of labour, however may be required later in the process to facilitate effective contractions.
49893
b
Intravenous oxytocin
QuestionChoice
Intravaginal prostaglandin E2 analogues such as Propess and Prostin are the first-line treatment in the induction of labour where there are no contraindications. These aim to soften and ripen the cervix in preparation for labour.
49892
a
Intravaginal prostaglandin E2 analogue e.g. Propess
QuestionChoice
Misoprostol, oral or vaginal, can be used to induce labour however is associated with an increased risk of uterine hyperstimulation
49895
d
An oral prostaglandin E1 analogue, e.g. misoprostol every 4 hours
QuestionChoice
This woman's cervix is described as very unfavourable, therefore insertion of a balloon catheter may be impossible. She has no contraindications to induction of labour using intravaginal prostaglandin E2 analogues such as Propress and Prostin.
49894
c
Foley intracervical balloon catheter
QuestionComment
I don't think that misoprostol is incorrect as of the most recent guidelines:

"For women with a Bishop score of 6 or less, offer induction of labour with dinoprostone as vaginal tablet, vaginal gel or controlled-release vaginal delivery system or with low dose (25 microgram) oral misoprostol tablets. [2021]"

This is different to the 2008 guidelines which state "1.3.2.3 Misoprostol10 should only be offered as a method of induction of
labour to women who have intrauterine fetal death (see
section 1.2.9) or in the context of a clinical trial."

Please update this?
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# Summary

Induction of labour is an artificially initiated process to start labour, usually applied for post-dates (>41 weeks gestation), preterm prelabour rupture of membranes, intrauterine foetal death, abnormal CTG, and certain maternal conditions. Contraindications include previous classical/vertical incision during caesarean section, multiple lower uterine segment caesarean sections, transmissible infections, and others. Methods include membrane sweep, vaginal prostaglandins, amniotomy, and balloon catheter. Management revolves around these methods, with careful monitoring and preparation for possible surgical intervention if necessary.


# Definition



Induction of labour is the medically initiated process of starting labour artificially. It is performed under specific circumstances to ensure the safety of the mother and the child.

# Indications



Induction of labour is typically indicated under certain conditions:

- Post-dates i.e. >41 weeks gestation
- Preterm prelabour rupture of membranes
- Intrauterine foetal death
- Abnormal CTG
- Maternal conditions such as pre-eclampsia, diabetes, cholestasis

# Contraindications 

Certain conditions pose a risk for labour induction:

- Previous classical/vertical incision during caesarean section
- Multiple lower uterine segment caesarean sections
- Transmissible infections e.g. herpes simplex
- Placenta praevia
- Malpresentations
- Severe foetal compromise
- Cord prolapse
- Vasa previa


# Investigations


Investigations for the need for labour induction can involve:

- Ultrasound scans: To confirm gestational age, foetal position, and placental location.
- Blood tests: To check the mother’s health status, particularly in cases of maternal conditions such as pre-eclampsia or diabetes.

# Management


The management of labour induction involves various methods:

- Membrane sweep: Inserting a gloved finger into the external os and separating the membranes from the cervix.
- Vaginal prostaglandins (PGE2): These are used to ripen the cervix and induce contractions.
- Amniotomy: Artificial rupture of membranes.
- Balloon catheter: This is inserted into the cervix to mechanically dilate it.

# References



[Click here for more information from NICE on Induction of Labour](https://www.nice.org.uk/guidance/CG70)
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Obstetrics
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Quesmed Tutorial: Obstetrics 2
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Management of pregnancy at 41 weeks
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A 24-year-old woman is attending for labour induction for a large-for-dates baby at 38+2 weeks gestation.

Her observations are as follows:

- Heart rate: 66 beats per minute
- Blood pressure: 124/76 mmHg
- Respiratory rate: 18 breaths per minute
- Oxygen saturations: 100% on room air
- Temperature: 36.7°C

A cardiotocograph is performed, which is reassuring.

A midwife performs a vaginal examination and describes her cervix as long, closed, firm, and posterior. Her Bishops score is 0.

What is the most appropriate management?
a