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Induction of labour ppt

  1. 1. INDUCTION OF LABOUR PRESENTED BY BIULA M.SC NSG FINAL YEAR P.G COLLEGE OF NURSING
  2. 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. 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. 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. 5. 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
  6. 6. 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
  7. 7. METHODS OF INDUCTION OF LABOUR 1. MEDICAL METHODS In medical methods drugs like 1. •Prostaglandins PGE2, PGE1 2. •Oxytocin •Mifiprestone
  8. 8. •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
  9. 9. 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.
  10. 10. 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.
  11. 11. ARTIFICIAL RUPTURE OF MEMBRANE USING AMNI- HOOK
  12. 12. AMNIOTOMY HOOK
  13. 13. 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
  14. 14. AMNIOTOMY
  15. 15. 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
  16. 16. 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
  17. 17. 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)
  18. 18. 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.
  19. 19. 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.
  20. 20. 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.
  21. 21. 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.
  22. 22. 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.
  23. 23. 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.
  24. 24. CONTRAINDICATIONS OF INDUCTION OF LABOUR •Major degree of placenta previa •Previous classical uterine incision •CPD •Active genital herpes infection
  25. 25. 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
  26. 26. NURSING RESPONSIBILITY
  27. 27. 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
  28. 28. 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
  29. 29. 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.
  30. 30. 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.
  31. 31. THANKYOU

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