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Induction of Labour

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  • 1. Induction of Labour
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  • 2. Introduction
    Refers to the process of artificial initiation of uterine contractions before their spontanuos onset, leading to cervical dilatation and effcacement and delivery of the baby.
    The term usually refers to procedures carried out in the third trimester but occasionally to gestations more than the legal definition of fetal viability (24 weeks)
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  • 3. Indications
    Generally, the purpose is to achieve benefit to the health of the mother or baby or both greater than if the pregnancy continues.
    Fetal
    Prolonged pregnancy (more than 41 weeks) ---- commonest indication
    IUGR, DM, Polyhydramnios, Macrosomia, Ruptured membranes, Multiple pregnancy, Rhesus iso-immunization, IUGR, oligohydramnios
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  • 4. Maternal
    Maternal disease e.g. renal disease, hypertensive disorders, DM, Auto-immune disease, Malignancy, IUFD
    Pregnancy related conditions e.g. PET, recurrent APH
    Maternal request--Reasons must be justified and the woman must be fully informed about disadvantages
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  • 5. Assessment before Induction
    Induction should only be performed in a setting with facilities to monitor both mother and fetus
    Check dates again ---? Early scan
    Fetal lie and presentation
    Fetal viability
    VE to assess the condition of the cervix
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  • 6. Methods of induction
    Traditional methods
    Castor oil, breast and nipple stimulation, sexual intercourse
    Little evidence to support efficacy and may sometimes be harmful
    Their use must be discouraged
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  • 7. Medical Interventions
    1- Mechanical
    Membrane sweeping
    Hygroscopic and mechanical dilators
    Extra-amniotic infusion of saline
    Amniotomy (ARM)
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  • 8. 2- Biochemical
    Prostaglandin E2
    Prostaglandin E2 is agent of choice
    Long chain fatty acids derived from arachidonic acid via the cyclo-oxygenase pathway
    Given via the oral, intra vaginal, intra-cervical or I.V routes
    Intra-vaginal gel and tablets have fewer side effects
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  • 9. Misoprostol
    Prostaglandin E1 analogue
    Oxytocin
    An octapeptide hormone secreted from the hypothalamus and stored in the pituitary
    Given via an infusion pump starting at a rate of 1-2mU/minute and doubling every 30 minutes to a maximum of 32 mU/ml
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  • 10. Choice of method
    Generally the more remote from term the more difficult the induction
    Most important consideration is cervical condition and ripeness
    Favorability of the cervix is assessed by Bishops score (or one of its modifications)
    Score less than 5 is un-favorable
    The lower the score, the more likely induction will fail and ripening with prostaglandins should be carried out
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  • 11. Complications of induction of labour
    Failed induction
    Cord prolapse
    Abruption
    Hyponatremia
    Uterine hyperstimulation
    Post-partum hemorrhage
    Prematurity
    Hyperbillirubinemia and jaundice
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  • 12. Special cases
    Induction following C/S
    Grandmutiparae
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