IOL

Question 1

IOL limitations-

Answer 1

• Need for vaginal examinations before and during
• Place of birth has to be LW
• Limited use of birth pool
• Need for instrumental
• EmCS- if fetal compromise from IOL
• Possible inc pain comapred to spont lab

Question 2

Explaining IOL

Answer 2

• Reason for IOL
• Process
• Alternatives- ie CS or IOL later
• Risks and benefits
• what if IOL does not work

Question 3

Decision making

Answer 3

• Leaflets
• Time to think and discuss
• Ask questions
• Respect the women’s decision

Question 4

Risks of IOL at 42 vs 39 weeks

Answer 4

Inc risk of CS w IOL
Higher risk of NNU admission and pernatal death

Question 5

Risks of IOL at 41 vs 42 weeks

Answer 5

Same outcomes for:
- Maternal and perinatal death
- Mec aspiration
- HIE
- Instrumental

Higher risk-
CS
NNU admission
Stillbirth

Hence explain to pt the higher risk to cont pregnancy past 42 weeks

Question 6

Ethnicity stillbirth risks

Answer 6

Black- 2x higher risk
Asian- 50% higher risk

Question 7

Declining IOL at 42 weeks

Answer 7

Weekly USS for AFI
Twice weekly CTG- only a snapshot, cannot predict outcome

Explain all the risks
Pt to contact MW if they change their mind

Question 8

PROM IOL

Answer 8

<37 weeks- conservative, IOL at 37w
>34 weeks +GBS- immediate IOL

> 37 weeks, no GBS- Expectant for 24h, then IV abx and IOL

Question 9

VBAC IOL

Answer 9

• Inc risk of CS
• Uterine rupture risk
• Use mechanical IOL

Womens choice for CS/IOL

Question 10

FGR

Answer 10

• If normal dopplers and no fetal compromise- can offer IOL
  If fetal compromise- CS

Question 11

Macrosomia mx

Answer 11

Expectant vs IOL
- IOL reduced risk of SD to expectant
- IOL inc risk of 3rd/4th deg tear
- Perinatal death, BPI and EmCS- same for both

Question 12

IU fetal death

Answer 12

• Discuss options- expectant, IOL, CS
  IOL (no scar)- Mife 200mg then miso
  IOL (scar)- Mechanical IOL

Question 13

Sweeps

Answer 13

From 39 weeks
Verbal consent
Risk of pain and bleeding
Can have >1

Question 14

Methods of IOL

Answer 14

• Mechanical - Lower risk of hyperstimulation, can use if prev CS
• Dinoprostone- hyperstimulation risk, CTG regularly.

If BS>6- ARM

Question 15

Forms of IOL NOT SUPPORTED (pharmacological)

Answer 15

Oral/IV/ extra amniotic/ intra-cervical dinoprostone, IV oxytocin alone, Hyaluronidase, steroids, oestrogen, relaxin, Mife

Question 16

Forms of IOL NOT SUPPORTED (Non- pharmacological)

Answer 16

Herbal supp, acupuncture, homeopathy, castor oil, hot bath, enema, intercourse

Question 17

Assessment before IOL-

Answer 17

• BS
• Fetal position- scan if unsure
• CTG for FH
• Check for contractions

Question 18

Assessment during IOL

Answer 18

• CTG if contracting
• Remove pessary or give tocolytics if needed

Question 19

In labour

Answer 19

Analgesia- IOL can be more painful

Question 20

OP IOL if low risk- LGA/PD

Answer 20

Pt to call if:
Contractions, SROM, bleeding, RFM

Question 21

Unsuccessful IOL

Answer 21

Discuss options
Rest and reassess
Other options for IOL
CS