Induction and Augmentation of Labour MCQs

The patient in the question has been having mild labor pains for 10 hours with no change in cervical dilatation and effacement. But again the question does not specify whether she is having regular uterine contractions or not. False labor can be differentiated from latent phase of labor by therapeutic rest i.eThe patient is sedated with morphine. So the correct option is Sedate and Wait. As far as augmentation with oxytocin is concerned - it is done only in those patients who even after therapeutic rest continue to be in prolonged latent phase (once the diagnosis of lack of progress of latent phase is confirmed following therapeutic rest.) Amniotomy is not useful and should be avoided in patients in prolonged latent phase. Also, there is no indication of cesarean section in this case. Reference : Fernando Arias 3/e, pg 376

Ripening of the cervix is changing the cervical matrix from sol to gel state by dissolving the collagen bundles. Ultimately the cervix becomes soft. Techniques for cervical ripening: Pharmacological: Dinoprostone gel (PGE 2 ) - it is the gold standard for cervical ripening Misoprostol (PGE1) tablet - vaginal or oral Steroid receptor antagonist Mifepristone Oxytocin Non pharmacological: Stripping the membrane Mechanical dilators: Osmotic dilators Balloon catheter/Transcervical catheter placed through internal os Extra-amniotic saline infusion Reference : Dutta Obs. 7/e, pg 524; Fernando Arias 3/e, pg 284-286; Williams Obs. 24/e, pg 525

Ans, C. To stop excess bleeding from uterus Methergin (methyl-ergo-novine) is a semisynthetic ergot derivative derived from lysergic acid. Indications Prophylactic:- Active management of 3rd stage of labour to prevent excess bleeding following delivery. Therapeutic:- To stop atonic uterine bleeding.

Misoprostol It is an analogue of Prostaglandin E 1 . Indications: Medical abortion in the first trimester of pregnancy. Evacuation of uterus in case of anembryonic pregnancies or early fetal demise. Ripening of cervix prior to second trimester abortions. Ripening of cervix and induction of labour in term pregnancies. For treatment and prevention of postpartum bleeding. Pharmacokinetics: It is available in tablet form. Metabolized in the liver. Complication: Nausea, vomiting, diarrhea. Uterine hyperstimulation. Contraindication: Women with previous uterine surgery particularly cesarean section. Reference : Dutta Obs. 7/e, pg 524; Fernando Arias 3/e, pg 286

Predisposing conditions: History of PPH Grand multipara Over distension of uterus: multiple pregnancy, polyhydramnios, big baby Malnutrition and anaemia APH Prolonged labour, induction/augmentation with oxytocin, precipitate labor Malformation of uterus, uterine fibroid Mismanaged 3 rd stage of labour Age>40 years, BMI> 35 Use of tocolytic drugs Reference: D C Dutta's textbook of obstetrics 8 th edition, chapter 28

After completing 42 weeks, labor induction is recommended to help avoid morbidity and mortality. Reference: Williams obstetrics 26 th edition, chapter 46

PROM ≥ 34 weeks and Wait for spontaneous onset of labor for 24 to 48 hr If fails induction of labor Reference : D C Dutta’s textbook of obstetrics 8 th edition, chapter 22

Rupture of membrane after 37 weeks Wait for spontaneous labor till 24 he if fails induction of labor Tocolysis, steroid, cerclage not recommended Reference : D C Dutta’s textbook of obstetrics 8 th edition, chapter 22