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MRCOG PART 2 SBAs and EMQs

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EMQ1500
SBA2111
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essay-261 induction of labour

essay-261 induction of labour Posted by Ritu J.
a]Induction of labor reduces the rate of caesarean delivery.
It does not increase the incidence of operative vaginal delivery.
It decreases the meconium andaspiration syndrome and decreases perinatal morbidity and mortality.
Waiting beyond 41 weeks increases the chance of intrauterine death,hence induction is justified.
It gives maternal satisfaction and avoids fear of uncertainity.
B]Induction of labour is associated with medicalisation of labour.
It can cause hypertonicity of uterus leading to fetal distress .
Continuous fetal monitoring is required whenever labour is induced.
Home birth can not be offered.Syntocinon induction is associated with maternal hypotension and antidiuretic effect in higher doses.
It also causes neonatal jaundice.Prostaglandin [cerviprime gel] is associated with diarrhoea,fever and hypertonus. and fetal bradycardia.
C]Sweeping and stetching the membranes is safe method which releases prostaglandins from choriodecidual membranes and initiates labour.
Prostaglandin gel can be applied intracervically/intravaginally to ripen the cervix.Hypertonic uterine contraction is less with vaginal gel.Intavaginal tab [gemeprost]is effective measure to induce pain. Misoprosttablet in smaller doses is effective method. Advantage is free mobility of woman during labour.
Prostaglandins like misoprost can be given orally in 25mg doses but one given dose cannot be titrated.
Oxytocin infusion is safe ,can be titrated,regulated and time honoured method for induction.
D]Iwould respect her wish but at the same time tell her about kick count to 10.Call her twice weekly for CTG,liquor volume, modified manning scoring.These methods predict only the current status.Vibroaciustic stimulation gives better reflection of neurological status.Umblical artey doppler velocity maesures are not of much use for prediction in such cases.
Give her helpline numbers and contact number for emergency.
Document thediscussion ,get refusal sighened and provide relevant written information .