CLASS 7 (4/21) INDUCTION OF LABOR AND ASSISTED BIRTH
| GUARANTEED SUCCESS STARTS HERE! LEARN,
PRACTICE & EXCEL!
Induction of labor Answer: - to stimulate uterine contractions during pregnancy before labor
begins on its own
Augmentation of labor Answer: - strengthens and increases frequency of uterine contractions
once labor has started
Birthing person indications for induction of labor (chronic conditions) Answer: - DM
- HTN
- renal, pulmonary, cardiac disease, etc
Birthing person indications for induction of labor (pregnancy related complications) Answer: -
pre-E
- GHTN
- PROM
- intramniotic infection
Fetal indications for induction of labor Answer: - Fetal compromise: IUGR, oligo, mild abruption,
non-reassuring FHT's
- Late term (41 weeks) or postdates (42 weeks)
Induction for suspected large baby Answer: - must be greater than 5000 gms (11 pounds) or
4500 gm (9.9 pounds) with DM or GDM
ARRIVE trial takeaway Answer: - trial of elective induction at 39 weeks
- did not improve the primary outcomes studied (death or serious newborn complications)
- decreased risk of pre-e and lower c-section rate
- not generalizable results
- Promote/encourage other methods of reducing risks of c-section-i.e. doulas, ambulation in
labor, IA, etc
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
, Increased risks associated with IOL Answer: - Inductions are associated with additional
interventions that may not always benefit the birthing person (epidurals, longer hospital stays,
postpartum hemorrhage, oxygen requirements for baby at delivery)
Bishop score Answer: - used to rate the readiness of the cervix for IOL
- Higher scores (≥8) associated with greater chance of having a vaginal delivery (cervix
favorable/ripe for IOL)
- Lower scores (≤6) associated with lower chance of vaginal delivery; prolonged labor (cervix is
unfavorable/unripe for IOL)
Cervical ripening Answer: the softening of the cervix to prepare for labor
Cervical ripening medications Answer: - cytotec
- Dinoprostone (expensive, gel or string)
Goal: to improve Bishop score, however, sometimes these interventions are enough to start
labor
Cytotec for ripening dosage Answer: - SL 25-50mcg q 2-4 hours x up to 6 doses in a 24-hour
period (PROM/PPROM)
- vaginally: 25mcg q4-6 hours x 4-6 doses
Cytotec for ripening contraindications Answer: - history of previous c-section
Cytotec for ripening vs. cytotec for post-partum hemorrhage Answer: ripening: 25-50mcg SL or
25mcg vaginally
hemorrhage: 800 to 1000 mcg SL, buccal, or rectally
What should be documented before starting cervical ripening meds Answer: - Prostaglandin's
can increase the patient's temperature- baseline V.S. before administration is needed
Other methods for cervical ripening Answer: - mechanical:
foley bulb
cook ballon (squeezes cervix between two baloons)
- membrane stripping/sweeping
Evicence-based natural methods of induction Answer: - acupuncture
- breast stimulation
- castor oil
- date fruit
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
| GUARANTEED SUCCESS STARTS HERE! LEARN,
PRACTICE & EXCEL!
Induction of labor Answer: - to stimulate uterine contractions during pregnancy before labor
begins on its own
Augmentation of labor Answer: - strengthens and increases frequency of uterine contractions
once labor has started
Birthing person indications for induction of labor (chronic conditions) Answer: - DM
- HTN
- renal, pulmonary, cardiac disease, etc
Birthing person indications for induction of labor (pregnancy related complications) Answer: -
pre-E
- GHTN
- PROM
- intramniotic infection
Fetal indications for induction of labor Answer: - Fetal compromise: IUGR, oligo, mild abruption,
non-reassuring FHT's
- Late term (41 weeks) or postdates (42 weeks)
Induction for suspected large baby Answer: - must be greater than 5000 gms (11 pounds) or
4500 gm (9.9 pounds) with DM or GDM
ARRIVE trial takeaway Answer: - trial of elective induction at 39 weeks
- did not improve the primary outcomes studied (death or serious newborn complications)
- decreased risk of pre-e and lower c-section rate
- not generalizable results
- Promote/encourage other methods of reducing risks of c-section-i.e. doulas, ambulation in
labor, IA, etc
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
, Increased risks associated with IOL Answer: - Inductions are associated with additional
interventions that may not always benefit the birthing person (epidurals, longer hospital stays,
postpartum hemorrhage, oxygen requirements for baby at delivery)
Bishop score Answer: - used to rate the readiness of the cervix for IOL
- Higher scores (≥8) associated with greater chance of having a vaginal delivery (cervix
favorable/ripe for IOL)
- Lower scores (≤6) associated with lower chance of vaginal delivery; prolonged labor (cervix is
unfavorable/unripe for IOL)
Cervical ripening Answer: the softening of the cervix to prepare for labor
Cervical ripening medications Answer: - cytotec
- Dinoprostone (expensive, gel or string)
Goal: to improve Bishop score, however, sometimes these interventions are enough to start
labor
Cytotec for ripening dosage Answer: - SL 25-50mcg q 2-4 hours x up to 6 doses in a 24-hour
period (PROM/PPROM)
- vaginally: 25mcg q4-6 hours x 4-6 doses
Cytotec for ripening contraindications Answer: - history of previous c-section
Cytotec for ripening vs. cytotec for post-partum hemorrhage Answer: ripening: 25-50mcg SL or
25mcg vaginally
hemorrhage: 800 to 1000 mcg SL, buccal, or rectally
What should be documented before starting cervical ripening meds Answer: - Prostaglandin's
can increase the patient's temperature- baseline V.S. before administration is needed
Other methods for cervical ripening Answer: - mechanical:
foley bulb
cook ballon (squeezes cervix between two baloons)
- membrane stripping/sweeping
Evicence-based natural methods of induction Answer: - acupuncture
- breast stimulation
- castor oil
- date fruit
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
