INDUCTION OF LABOUR

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INDUCTION OF LABOUR
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DEFINITION

• Artificial stimulation of uterine contractions
  before spontaneous onset of labour with the
  purpose of accomplishing successful vaginal
  delivery

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INDICATIONS

• MATERNAL
• Preeclampsia, eclampsia
• PROM
• Postterm preg
• Abruptio placenta
• Chorioamnionitis
• Medical conditions-DM,Heart ds, Renal ds,Chr. HT
  etc

• FETAL
• IUFD
• Fetal anomaly incompatible with life
• Severe IUGR
• Rh isoimmunisation
• Macrosomia

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CONTRAINDICATIONS

• Severe degree CPD
• Major degree placenta praevia
• Transverse lie
• Previous classical CS,Myomectomy
• Previousgt 2 LSCS
• Grand multiparity
• Active genital herpes
• Hypersensitivity to inducing agent

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RISKS OF INDUCTION

• Failure leading to CS
• Uterine hyperstimulation
• Fetal distress,death
• Rupture uterus
• Intrauterine infection,sepsis
• Iatrogenic delivery of preterm infant
• Precipitate/dysfunctional labour
• Inc. risk of operative vaginal delivery
• Inc. risk of birth trauma
• Inc. risk of PPH

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PREREQUISITES

• Establish indication clearly
• Informed consent
• Conformation of gestational age
• Assessment of fetal size presentation
• Pelvic assessment
• Cervical assessment (BISHOPs score)
• Availability of trained personnel

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MOD. BISHOPS SCORE
SCORE 0 1 2 3
DILATATION 0 1-2 3-4 gt4
EFFACEMENT 0-30 40-50 60-70 gt80
STATION -3 -2 -1/0 1,2,3
CONSISTENCY firm medium soft
POSITION posterior mid anterior
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METHODS OF INDUCTION

• CHEMICAL
• NONHORMONAL
• Herbs,evening primrose oil
• Homeopathic prep
• Enemas
• Castor oil
• HORMONAL
• Oxytocin
• Prostaglandins PGE2,Misoprostol
• Relaxin
• Nitric oxide donors
• mifepristone

• NATURAL
• Breast/nipple stimulation
• Sexual intercourse
• Membrane stripping
• Amniotomy
• Acupuncture/acupressure
• MECHANICAL
• Balloon catheters
• Lamineria tents
• Synthetic osmotic dilators