The contraindications of Induction of Labour include the following, EXCEPT?

AIIMS Raipur NO - 2017 (Shift-1)

Obstetrics & Gynaecology

Hard

Appeared in: AIIMS Raipur NO - 2017 (Shift-1)

Explanation

Fetal macrosomia, or a large-for-gestational-age fetus, is considered a relative contraindication for labor induction.
While a large baby increases the risk of complications such as shoulder dystocia, failed induction, and postpartum hemorrhage, it does not automatically rule out induction.
The decision to induce for macrosomia is complex and involves weighing the risks of induction against the risks of allowing the pregnancy to continue (e.g., further fetal growth).
Unlike the other options, vaginal delivery is still potentially possible, making it the exception among the choices provided.

Option A: Placenta praevia is an absolute contraindication for labor induction. The placenta is implanted in the lower uterine segment, covering the cervical os partially or completely.
Option C: Cord presentation (or prolapse) is an absolute contraindication and an obstetric emergency. The umbilical cord lies in front of or beside the presenting part.
Option D: Cephalopelvic disproportion (CPD) is an absolute contraindication. This means there is a mismatch between the size of the fetal head and the maternal pelvis.

Visual 1: Table - A comparison table outlining absolute vs. relative contraindications for labor induction, with clear rationales for each. This helps differentiate conditions where induction is never an option versus where it's a complex decision.
Visual 2: Infographic - An infographic illustrating the dangers of inducing labor with absolute contraindications like placenta previa (showing hemorrhage risk), cord prolapse (showing cord compression), and CPD (showing obstructed labor).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Induction of Labour as background academic context rather than a clinical decision trigger.
Nurses play a critical role in the pre-induction assessment by verifying that there are no absolute contraindications. This is a crucial patient safety check before administering uterotonic agents like oxytocin.
Accurate assessment and documentation of fetal presentation, placental location (from ultrasound reports), and pelvic adequacy are essential nursing responsibilities.
What if? If a patient with known fetal macrosomia also has poorly controlled gestational diabetes, the provider might be more inclined to recommend induction around 39 weeks to prevent further fetal growth and reduce the risk of stillbirth associated with post-term diabetic pregnancies. The nurse must be prepared for a higher-risk delivery, including the potential for shoulder dystocia.

How to Approach the Question

First, identify the keyword 'EXCEPT' in the question. This means you are looking for the option that does not belong with the others.
The question asks for contraindications to labor induction. Therefore, three of the options will be valid contraindications, and one will not be (or will be a relative, not absolute, contraindication).
Evaluate each option's relationship to labor induction:
Placenta Praevia: Think about the anatomy. The placenta is blocking the exit. Inducing contractions would cause severe bleeding. This is a definite contraindication.
Cord Presentation: The cord is the baby's lifeline. If it's presenting first, contractions will squeeze it. This is an emergency and a definite contraindication.
Cephalopelvic Disproportion: The baby's head is too big for the pelvis. Forcing labor won't work and is dangerous. This is a definite contraindication.

Concept Tested & Keywords

Concept Tested: Contraindications for Induction of Labour
Stem keywords: Induction of Labour, contraindications
Lead-in keywords: EXCEPT
Negative lead-in flag: The question asks for the EXCEPTION, meaning the option that is NOT an absolute contraindication.

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