ACOG Practice Bulletin (Induction Of Labor) -
Questions With Clear Solutions
How do you appropriately measure uterine contractions? Right Ans - Count
the number of contractions present in a ten minute window averaged over 30
minutes.
Review: What is normal uterine activity during labor and what constitutes
tachysystole? Right Ans - -Normal: five contractions or less in 10 minutes
(averaged over 30 minutes)
-Tachysystole: more than 5 contractions in ten minutes (averaged over 30
minutes)
Review: What data must always be given with the description of tachysystole?
Right Ans - Tachysystole should always be qualified as to the presence or
absence of associated FHR decelerations
Mostly review: What are some clinical scenarios in which labor induction may
be indicated? Right Ans - -Placental abruption
-Chorioamnionitis
-Fetal demise
-Gestational HTN
-Preeclampsia/eclampsia
-PROM
-Postterm pregnancy
-Maternal medical conditions (DM, renal disease, chronic pulmonary disease,
chronic HTN, antiphospholipid syndrome)
-Fetal compromise (severe growth restriction, isoimmunization,
oligohydramnios
Partial review: What are some non-clinical scenarios in which labor induction
may be warranted? Right Ans - -Logistical reasons such as risk of rapid
labor, distance form the hospital, or psychosocial indications
*A mature fetal lung test result before 39 weeks of gestation, in the absence of
appropriate clinical circumstances, is not an indication for delivery*
, Mostly review: What are the contraindications for labor induction? Right
Ans - Basically, they are the same contraindications as those for spontaneous
labor and vaginal delivery:
-Vasa previa/complete placenta previa
-Transverse fetal lie
-Umbilical cord prolapse
-*Previous classical cesarean delivery*
-Active genital herpes infection
-Previous myomectomy entering the endometrial cavity
What is the goal of cervical ripening? Right Ans - It is to facilitate the
process of cervical softening, thinning, and dilating with the resultant
reduction in the rate of failed induction and induction to delivery time.
Review: What is the generally regarded cutoff for a cervix that is unfavorable
for induction? Right Ans - This is when the bishop score is 6 or less.
Review: What are the different methods for cervical ripening? Right Ans - -
Mechanical cervical dilators (including hygroscopic dilators, osmotic dilators,
Foleys, extraamniotic saline infusions)
-Synthetic PGE1 or PGE2
Review: What are the PGE1 and PGE2 analogs and how are they
administered? Right Ans - -PGE1: Misoprostol. Administered intravaginally,
orally, sublingually, and rectally.
-PGE2: Dinoprostone. Gel and vaginal insert.
Review: What are the different methods for induction of labor (*after cervix is
ripe*)? Right Ans - -Oxytocin
-Membrane stripping
-Amniotomy
-Nipple stimulation
What are predictors of a successful response to oxytocin for induction?
Right Ans - -Lower BMI
-Greater cervical dilation, parity or gestational age
Questions With Clear Solutions
How do you appropriately measure uterine contractions? Right Ans - Count
the number of contractions present in a ten minute window averaged over 30
minutes.
Review: What is normal uterine activity during labor and what constitutes
tachysystole? Right Ans - -Normal: five contractions or less in 10 minutes
(averaged over 30 minutes)
-Tachysystole: more than 5 contractions in ten minutes (averaged over 30
minutes)
Review: What data must always be given with the description of tachysystole?
Right Ans - Tachysystole should always be qualified as to the presence or
absence of associated FHR decelerations
Mostly review: What are some clinical scenarios in which labor induction may
be indicated? Right Ans - -Placental abruption
-Chorioamnionitis
-Fetal demise
-Gestational HTN
-Preeclampsia/eclampsia
-PROM
-Postterm pregnancy
-Maternal medical conditions (DM, renal disease, chronic pulmonary disease,
chronic HTN, antiphospholipid syndrome)
-Fetal compromise (severe growth restriction, isoimmunization,
oligohydramnios
Partial review: What are some non-clinical scenarios in which labor induction
may be warranted? Right Ans - -Logistical reasons such as risk of rapid
labor, distance form the hospital, or psychosocial indications
*A mature fetal lung test result before 39 weeks of gestation, in the absence of
appropriate clinical circumstances, is not an indication for delivery*
, Mostly review: What are the contraindications for labor induction? Right
Ans - Basically, they are the same contraindications as those for spontaneous
labor and vaginal delivery:
-Vasa previa/complete placenta previa
-Transverse fetal lie
-Umbilical cord prolapse
-*Previous classical cesarean delivery*
-Active genital herpes infection
-Previous myomectomy entering the endometrial cavity
What is the goal of cervical ripening? Right Ans - It is to facilitate the
process of cervical softening, thinning, and dilating with the resultant
reduction in the rate of failed induction and induction to delivery time.
Review: What is the generally regarded cutoff for a cervix that is unfavorable
for induction? Right Ans - This is when the bishop score is 6 or less.
Review: What are the different methods for cervical ripening? Right Ans - -
Mechanical cervical dilators (including hygroscopic dilators, osmotic dilators,
Foleys, extraamniotic saline infusions)
-Synthetic PGE1 or PGE2
Review: What are the PGE1 and PGE2 analogs and how are they
administered? Right Ans - -PGE1: Misoprostol. Administered intravaginally,
orally, sublingually, and rectally.
-PGE2: Dinoprostone. Gel and vaginal insert.
Review: What are the different methods for induction of labor (*after cervix is
ripe*)? Right Ans - -Oxytocin
-Membrane stripping
-Amniotomy
-Nipple stimulation
What are predictors of a successful response to oxytocin for induction?
Right Ans - -Lower BMI
-Greater cervical dilation, parity or gestational age
