Induction of Labor

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Induction of Labor

• By
• A.MALIBARY,M.D.

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• Induction
• The process whereby labor is initiated
  artificially

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• Augmentation
• The artificial stimulation of labor that has been
  started spontaneously

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Indication for Induction

• Maternal
• Fetal

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• Maternal
• IUFD
• Polyhydramnios
• PET
• Heart diseases
• D.M

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• Fetal
• Prolonged Pregnancy
• IUGR
• Rh isoimmunization
• Unexplained IUD in prior pregnancy
• PROM
• Chorioamnionitis
• Malformation
• Others

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• Combined
• Pregnancy-induced hypertension
• Chronic renal diseases
• Bad obstetric history
• APH

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Contraindications

• -Contracted pelvis
• -Major degree of CPD
• -Pregnancy following classical C.section
• -Pregnancy following repair of a vesico-vaginal
  fistula
• -Overdistended uterus
• -Preterm fetus without lung maturity
• -Acute fetal distress
• -Abnormal presentation
• -Presence of active herpetic genital lesions

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Assessment for Induction

• Prior to induction of labor the following have to
  be considered carefully
• -The period of gestation and edd needs careful
  checking
• -Assessment of any CPD is important
• -Fetal malpresentation
• -Cervical assessment ( Bishops score )
• -Station of presenting part

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• All the parameters are not equally important
• Cervical dilatation and station of the presenting
  part are more important than the rest of the
  parameters
• Higher scores are commonly referred to as a
  Ripe cervix
• The ripeness of the cervix is linked to easier
  induction with shorter interval between induction
  and the onset of labor

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• The unripe cervix does not preclude induction
  it is only indicates a longer latent phase
  following induction

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Method of Induction

• Oxytocin
• Discovered by du Vagneaud in America in 1953
• Octapeptide
• Synthetic Oxytocin preparations, Syntocinon and
  Pitocin are commonly used
• Syntocinon is avaiable in injections

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• Actions
• Uterus Rhythmical contractions
• Brest Stimulation
• Cardiovascular system
• Water retension

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• Dose 10 units of Oxytocin in 1000 ml in 5
  Dextrose Starting Dose 1 mU/ min
• IV infusion
• Infusio pump
• Important Point
• Close and Constant supervision for uterine
  contractions fetal heart rate progress of
  labor

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• Complications of Syntocinon
• Incoordinate uterine actionhyperstimulation
• Fetal hypoxia
• Uterine rupture
• Water intoxication
• Uterine fatiguePPH

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• Prostaglandins
• Extract of human seminal fluid was observed to
  possess smooth muscle stimulation and blood
  pressure lowering activity by von Euler

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• Routes of administration
• Oral
• Vaginal-Gel or Pessary
• Local via catheter
• Intravenous PGF 2 _at_
• Intramuscular

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• Contraindications
• Bronchial asthma
• Epilepsy
• Hypersensitivity
• Renal disease
• Hypertension
• Peptic ulcer

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• Amniotomy (ARM)
• Widely used methodology
• Easy
• No anaesthesia or analgesia
• Safe
• Cord prolapse
• Chorioamnionitis

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• Risk of Induction
• Failure
• Prematurity
• Abnormal uterine action
• Infection
• Maternal exhaustion
• Fetal hypoxia
• Amniotic fluid embolism

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• Result of Induction
• The success of induction can not really be
  measured by the favorable outcome of a vaginal
  delivery, The time interval between induction and
  the onset of labor is more realistic goal and
  this mainly depend on

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• Proximity to term
• Condition of the cervix
• Method of induction
• Station of PP
• Amount of liquor drained

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• drmalibary_at_yahoo.ca
• THANK U
• 9/2007