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INDUCTION OF LABOUR
PRESENTED BY
BIULA
M.SC NSG FINAL YEAR
P.G COLLEGE OF NURSING
INTRODUCTION
The culmination of normal pregnancy involves
three stages: pre labour, cervical ripening and
labour. Endogenous prostaglandin play a part
in all these processes. Intervention to
artificially ripen the cervix, induce uterine
contractions and argument labour once it is
progress also lack distinct boundaries.
DEFINITION
1. ACCORDING TO D.C DUTTA
“Induction of labour is defined as artificial
stimulation of uterine contraction before the
onset of labour. Augmentation refers to
stimulation of spontaneous contraction that
are considered inadequate because of failed
cervical dilatation and fetal descent.”
GOALS
The goal of induction of labour to
eliminate the potential risks to the fetus
with prolonged intrauterine existence
while minimizing the likelihood of
operative delivery.
INDICATIONS OF INDUCTION LABOUR
1.
HYPERTENSIVE
DISORDER OF
PREGNANCY
2. DIABETES,
RENAL DISEASE
3. CHRONIC
PULMONARY
DISEASE
4. PREMATURE
RUPTURE OF
MEMBRANE
5. RH
ISOIMMUNIZA
TION
6. POSTDATED
PREGNANCY
METHODS OF INDUCTION OF LABOUR AND THE COMMON
CLINICAL CONDITIONS
MEDICAL METHODS SURGICAL
METHODS
COMBINED
METHODS
MEDICAL METHODS SURGICAL
METHODS
COMBINED
METHODS
1. Intrauterine fetal
death
2. Premature
rupture of
membranes
3. In combination
with surgical
induction (ARM)
1. Abruptio
placenta
2. Chronic
hydramnios
3. Severe pre-
eclampsia
4. In combination
with medical
induction
5. To place scalp
electrode for
electronic fetal
monitoring
1. To shorten the
induction –
delivery interval.
2. Medical methods
followed by
surgical or
surgical methods
followed by
medical
METHODS OF INDUCTION OF LABOUR
1. MEDICAL METHODS
In medical methods drugs like
1.
•Prostaglandins
PGE2, PGE1
2.
•Oxytocin
•Mifiprestone
•PGE2 and PGF2 both cause myometrial
contraction
•PGE2 is primarily important for cervical
ripening (0.5mg)
•PGE1 which is known as misoprostol is
currently being used either Transvaginal
or orally.
•Mifipristone blocks both progesterone
and Glucocorticoids receptors
•200mg vaginally daily for 2days
OXYTOCIN
1. It is an endogenous uterotonic that stimulates
uterine contractions. Oxytocin receptors present in
the myometrium are more in the fundus than in the
cervix.
2. Receptors concentrations increase during
pregnancy and in labour.
3. Oxytocin acts by
a.Receptor mediation
b.Voltage mediated calcium channels
c. Prostaglandin production
4. Oxytocin is effective for induction of labour when
the cervix is ripe. It is less effective as a cervical
ripening agents.
2. SURGICAL METHODS
Surgical methods include membrane sweep
and artificial rupture of membrane.
“membrane sweep also known as membrane
stripping, or stretch and sweep.
Artificial rupture of membrane is also done
low rupture of the membranes and high
rupture o f membranes. It is also known as
amniotomy.
ARTIFICIAL RUPTURE OF MEMBRANE USING AMNI-
HOOK
AMNIOTOMY HOOK
MECHANISM OF ONSET OF LABOUR
May be related with
a)Stretching of the cervix
b)Separation of the membranes (liberation of
prostaglandins)
c) Reduction of amniotic fluid volume
AMNIOTOMY
ADVANTAGE OF AMNIOTOMY
A)High success rate
B)Chance to observe the amniotic fluid for blood or
meconium
C)Access to use fetal scalp electrode or intrauterine
pressure catheter or fetal scalp blood sampling
LIMITATION
It cannot be employed in an unfavorable cervix.
The cervix should be at least one finger dilated
IMMEDIATE BENEFICIAL EFFECTS OF ARM
1. Lowering of the blood pressure in pre-eclampsia-
eclampsia
2. Relief of maternal distress in hydramnios
3. Control of bleeding in APH
4. Relief of tension in abruption placenta and
initiation of labour
HAZARDS OF ARM
Once the procedure is adopted, there is no scope of
retreating from the decision of delivery
Chance of umbilical cord prolapse : the risk is low
with engaged head or rupture of membranes with
head fixed to the brim
Amnionitis: careful selection of cases with
favorable pre induction score will shorten the
induction delivery interval.
Accidental injury to the placenta, cervix or uterus,
fetal parts. Care taken during rupture of the
membranes minimizes the problems
Liquor amnii embolism (rare)
LOW RUPTURE OF MEMBRANES (LRM)
It is widely practiced nowadays with high degree of
success. The membranes below the presenting part
over lying the internal os are ruptured to drain some
amount of amniotic fluid.
PROCEDURES
PRELIMINARIES: It is an outdoor procedure.
The patient is asked to empty to bladder. The
procedure may be conducted in the labour
ward or in the operation theatre if the risk of
cord prolapse is high.
ACTUAL STEPS
The patient is in lithotomy position
Full surgical asepsis is to be taken
Two fingers are introduced into the vagina
smeared with antiseptic ointment. The index finger is
passed through the cervical canal beyond the
internal os. The membranes are swept free from the
lower segment as far as reached by the finger
With one or two fingers still in the cervical canal
with the palmer surface upwards, a long Kocher's
forceps with the blades closed or an amnion hook is
introduced along the palmer aspect of the fingers up
to the membranes.
The blades are opened to seize the
membranes and are torn by twisting
movements. Amnihook is used to scratch over
the membranes. This is followed by visible
escape of amniotic fluid.
STRIPPING THE MEMBRANES
Stripping of the membranes means digital
separation of the chorioamniotic membranes
from the wall of the cervix and lower uterine
segment. Sweeping of membranes is done
prior to ARM. It is simple, safe and beneficial
for induction of labour.
3. COMBINED METHODS
1. Combine medical and surgical methods are
commonly use to increase the efficacy of
induction by reducing the induction –
delivery interval.
2. The Oxytocin infusion is started either prior
to or following rupture of membranes
depending mainly upon the state of cervix
and head brim relation
3. With the head not engaged, it is preferably
to induce with prostaglandin gel or to start
Oxytocin infusion followed by AROM.
CONTRAINDICATIONS OF INDUCTION OF LABOUR
•Major
degree
of
placenta
previa
•Previous
classical
uterine
incision
•CPD
•Active
genital
herpes
infection
MATERNAL AND NEONATAL OUTCOME
1. Regular &
rhythmic
uterine
contraction
2. Progress
in cervical
dilation
3. Shortens
the duration
of labour
4. Good
effacement
of the cervix
5. Low
incidence of
caesarean
section
6. Less
maternal
anxiety
7. Fast
delivery of
the baby
8. Fetal
hypoxia can
be detected
early
9. Decrease
neonatal
mortality
rate
NURSING RESPONSIBILITY
NURSING RESPONSIBILITY OF MEDICAL INDUCTION
1. Nurse should know about the administration of drugs
2. Nurse should administer PGE2 gel 0.5mg before the cervical
ripening
3. Nurse should observe about the cervical ripening
4. Nurse should monitor for 30min after she should given
drugs 3 or 4 doses after 6hrs.
5. Nurse should know about the dose and route of
misoprostol drugs
6. Nurse should administer 25g vaginally every 4hours
7. Nurse should know about the preparation of Oxytocin
solution
8. Oxytocin should be started in low dose with interval of 20-
30minutes
9. Oxytocin should be administer 2units in 500ml ringer
solution with drop rate of 60/minutes
NURSING RESPONSIBILITY OF SURGICAL INDUCTION
OF LABOUR
1. Nurse should maintain aseptic techniques
2. She should provide proper position to the patient
3. She should do vaginal examination with the use
of proper aspetic techniques
4. She should known about how to assess in
procedure of low rupture of membrane
5. She should know about the instruments which is
used in the surgical induction of labour
6. She should know how to use Amni hook
7. She should observe by visible escape of amniotic
fluid
GENERAL NURSING RESPONSIBILITY
1. AFETR THE MEMBRANE RUPTURED
a. Check FHR
b. Check rate of infusion
c. Check uterine contractions and FHR 15min
2. GENERAL CARE
2. Nurses provide care to women and their newborn during
the ante partum, post partum and neonatal stages of this
important life event.
3. They assess each mother and baby and develop an
individualized plan of care
4. They implement the plan of care by monitoring the mother
and baby and by teaching patients about their care and
topics related to women’s health and newborn care.
5. Nurses evaluate the effectiveness of the
care plan and modify it is needed to meet the
changing needs of the mother, newborn and
family
6. They also provide psychological and
emotional support to patients and families.
THANKYOU

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Induction of labour ppt

  • 1. INDUCTION OF LABOUR PRESENTED BY BIULA M.SC NSG FINAL YEAR P.G COLLEGE OF NURSING
  • 2. INTRODUCTION The culmination of normal pregnancy involves three stages: pre labour, cervical ripening and labour. Endogenous prostaglandin play a part in all these processes. Intervention to artificially ripen the cervix, induce uterine contractions and argument labour once it is progress also lack distinct boundaries.
  • 3. DEFINITION 1. ACCORDING TO D.C DUTTA “Induction of labour is defined as artificial stimulation of uterine contraction before the onset of labour. Augmentation refers to stimulation of spontaneous contraction that are considered inadequate because of failed cervical dilatation and fetal descent.”
  • 4. GOALS The goal of induction of labour to eliminate the potential risks to the fetus with prolonged intrauterine existence while minimizing the likelihood of operative delivery.
  • 5.
  • 6. INDICATIONS OF INDUCTION LABOUR 1. HYPERTENSIVE DISORDER OF PREGNANCY 2. DIABETES, RENAL DISEASE 3. CHRONIC PULMONARY DISEASE 4. PREMATURE RUPTURE OF MEMBRANE 5. RH ISOIMMUNIZA TION 6. POSTDATED PREGNANCY
  • 7.
  • 8. METHODS OF INDUCTION OF LABOUR AND THE COMMON CLINICAL CONDITIONS MEDICAL METHODS SURGICAL METHODS COMBINED METHODS MEDICAL METHODS SURGICAL METHODS COMBINED METHODS 1. Intrauterine fetal death 2. Premature rupture of membranes 3. In combination with surgical induction (ARM) 1. Abruptio placenta 2. Chronic hydramnios 3. Severe pre- eclampsia 4. In combination with medical induction 5. To place scalp electrode for electronic fetal monitoring 1. To shorten the induction – delivery interval. 2. Medical methods followed by surgical or surgical methods followed by medical
  • 9. METHODS OF INDUCTION OF LABOUR 1. MEDICAL METHODS In medical methods drugs like 1. •Prostaglandins PGE2, PGE1 2. •Oxytocin •Mifiprestone
  • 10.
  • 11. •PGE2 and PGF2 both cause myometrial contraction •PGE2 is primarily important for cervical ripening (0.5mg) •PGE1 which is known as misoprostol is currently being used either Transvaginal or orally. •Mifipristone blocks both progesterone and Glucocorticoids receptors •200mg vaginally daily for 2days
  • 12. OXYTOCIN 1. It is an endogenous uterotonic that stimulates uterine contractions. Oxytocin receptors present in the myometrium are more in the fundus than in the cervix. 2. Receptors concentrations increase during pregnancy and in labour. 3. Oxytocin acts by a.Receptor mediation b.Voltage mediated calcium channels c. Prostaglandin production 4. Oxytocin is effective for induction of labour when the cervix is ripe. It is less effective as a cervical ripening agents.
  • 13. 2. SURGICAL METHODS Surgical methods include membrane sweep and artificial rupture of membrane. “membrane sweep also known as membrane stripping, or stretch and sweep. Artificial rupture of membrane is also done low rupture of the membranes and high rupture o f membranes. It is also known as amniotomy.
  • 14. ARTIFICIAL RUPTURE OF MEMBRANE USING AMNI- HOOK
  • 16.
  • 17.
  • 18.
  • 19. MECHANISM OF ONSET OF LABOUR May be related with a)Stretching of the cervix b)Separation of the membranes (liberation of prostaglandins) c) Reduction of amniotic fluid volume
  • 21. ADVANTAGE OF AMNIOTOMY A)High success rate B)Chance to observe the amniotic fluid for blood or meconium C)Access to use fetal scalp electrode or intrauterine pressure catheter or fetal scalp blood sampling LIMITATION It cannot be employed in an unfavorable cervix. The cervix should be at least one finger dilated
  • 22. IMMEDIATE BENEFICIAL EFFECTS OF ARM 1. Lowering of the blood pressure in pre-eclampsia- eclampsia 2. Relief of maternal distress in hydramnios 3. Control of bleeding in APH 4. Relief of tension in abruption placenta and initiation of labour
  • 23. HAZARDS OF ARM Once the procedure is adopted, there is no scope of retreating from the decision of delivery Chance of umbilical cord prolapse : the risk is low with engaged head or rupture of membranes with head fixed to the brim Amnionitis: careful selection of cases with favorable pre induction score will shorten the induction delivery interval. Accidental injury to the placenta, cervix or uterus, fetal parts. Care taken during rupture of the membranes minimizes the problems Liquor amnii embolism (rare)
  • 24. LOW RUPTURE OF MEMBRANES (LRM) It is widely practiced nowadays with high degree of success. The membranes below the presenting part over lying the internal os are ruptured to drain some amount of amniotic fluid.
  • 25.
  • 26. PROCEDURES PRELIMINARIES: It is an outdoor procedure. The patient is asked to empty to bladder. The procedure may be conducted in the labour ward or in the operation theatre if the risk of cord prolapse is high.
  • 27. ACTUAL STEPS The patient is in lithotomy position Full surgical asepsis is to be taken Two fingers are introduced into the vagina smeared with antiseptic ointment. The index finger is passed through the cervical canal beyond the internal os. The membranes are swept free from the lower segment as far as reached by the finger With one or two fingers still in the cervical canal with the palmer surface upwards, a long Kocher's forceps with the blades closed or an amnion hook is introduced along the palmer aspect of the fingers up to the membranes.
  • 28. The blades are opened to seize the membranes and are torn by twisting movements. Amnihook is used to scratch over the membranes. This is followed by visible escape of amniotic fluid.
  • 29. STRIPPING THE MEMBRANES Stripping of the membranes means digital separation of the chorioamniotic membranes from the wall of the cervix and lower uterine segment. Sweeping of membranes is done prior to ARM. It is simple, safe and beneficial for induction of labour.
  • 30.
  • 31. 3. COMBINED METHODS 1. Combine medical and surgical methods are commonly use to increase the efficacy of induction by reducing the induction – delivery interval. 2. The Oxytocin infusion is started either prior to or following rupture of membranes depending mainly upon the state of cervix and head brim relation 3. With the head not engaged, it is preferably to induce with prostaglandin gel or to start Oxytocin infusion followed by AROM.
  • 32. CONTRAINDICATIONS OF INDUCTION OF LABOUR •Major degree of placenta previa •Previous classical uterine incision •CPD •Active genital herpes infection
  • 33. MATERNAL AND NEONATAL OUTCOME 1. Regular & rhythmic uterine contraction 2. Progress in cervical dilation 3. Shortens the duration of labour 4. Good effacement of the cervix 5. Low incidence of caesarean section 6. Less maternal anxiety 7. Fast delivery of the baby 8. Fetal hypoxia can be detected early 9. Decrease neonatal mortality rate
  • 35. NURSING RESPONSIBILITY OF MEDICAL INDUCTION 1. Nurse should know about the administration of drugs 2. Nurse should administer PGE2 gel 0.5mg before the cervical ripening 3. Nurse should observe about the cervical ripening 4. Nurse should monitor for 30min after she should given drugs 3 or 4 doses after 6hrs. 5. Nurse should know about the dose and route of misoprostol drugs 6. Nurse should administer 25g vaginally every 4hours 7. Nurse should know about the preparation of Oxytocin solution 8. Oxytocin should be started in low dose with interval of 20- 30minutes 9. Oxytocin should be administer 2units in 500ml ringer solution with drop rate of 60/minutes
  • 36. NURSING RESPONSIBILITY OF SURGICAL INDUCTION OF LABOUR 1. Nurse should maintain aseptic techniques 2. She should provide proper position to the patient 3. She should do vaginal examination with the use of proper aspetic techniques 4. She should known about how to assess in procedure of low rupture of membrane 5. She should know about the instruments which is used in the surgical induction of labour 6. She should know how to use Amni hook 7. She should observe by visible escape of amniotic fluid
  • 37. GENERAL NURSING RESPONSIBILITY 1. AFETR THE MEMBRANE RUPTURED a. Check FHR b. Check rate of infusion c. Check uterine contractions and FHR 15min 2. GENERAL CARE 2. Nurses provide care to women and their newborn during the ante partum, post partum and neonatal stages of this important life event. 3. They assess each mother and baby and develop an individualized plan of care 4. They implement the plan of care by monitoring the mother and baby and by teaching patients about their care and topics related to women’s health and newborn care.
  • 38. 5. Nurses evaluate the effectiveness of the care plan and modify it is needed to meet the changing needs of the mother, newborn and family 6. They also provide psychological and emotional support to patients and families.