Inducing Labor Summary (NICE) – EMQ

Options for questions 1 – 5

a.Vaginal dinoprostone gel

b.Vaginal misoprostol 75 mcg

c.Vaginal misoprostol followed by oral mifepristone

d.Oral mifepristone 200 mg followed by vaginal misoprostol

e.Oral mifepristone 400 mg

f.Oral mifepristone 200 mg

g.Oral misoprostol 25 mcg

h.Entonox

i.Amniotomy

j.Amniotomy with oxytocin infusion

k.Balloon catheter

l.Tocolysis

m.Castor oil

For each scenario given below chose the single most appropriate method of induction of labour. Each option can be chosen once, more than once or not at all.

1. Ms. AB, 32 years old para1 is 36 weeks pregnant. Her previous delivery was at 39 weeks by an emergency CS for breech presentation with cord prolapse. She wants to discuss her mode of induction this time.

2. 29 year old primi presented with reduced fetal movements at 32 weeks gestation. An ultrasound confirmed intrauterine fetal death. She declines to have any intervention at present. After 2 days she comes to the midwifery care now that she has changed her mind and wants to deliver the baby.

3. A 39 year old primi has been induced with vaginal dinoprostone gel for post - dated pregnancy. A membrane sweep had failed to induce labour. She is being constantly monitored. The CTG is suggestive of a normal fetus, however she starts to complain of severe pain. She is having 6 uterine contractions in 20 minutes each lasting for more than 10 seconds.

4. A 29 year old para1 in her second pregnancy is at 42 weeks awaiting spontaneous labour. She has had membrane sweeping done 2 times but she has still not gone into labour. On assessment her Bishop score is 9.

5. Ms. XY, 32 years old is in her second pregnancy and is currently 41 weeks pregnant. She declines to have any intervention. She has heard there are some methods which are not medicinal but can still help in inducing labour. However, induction of labour is not recommended by such methods: