IOL

1. INDUCTION OF LABOUR

2. DEFINITION
Induction of labor means initiation of uterine contractions by any method
(medical, surgical or combined) for the purpose of vaginal delivery.
Artificial stimulation of uterine contractions before spontaneous onset of
labor with the purpose of accomplishing successful vaginal delivery

3. PURPOSE OF INDUCTION OF
LABOUR:
WHEN THE RISK OF CONTINUATIONS
OF PREGNANCY EITHER TO THE
MOTHER OR TO THE FETUS IS MORE,
INDUCTION IS INDICATED.

4. INDICATIONS
MATERNAL
• PREECLAMPSIA,
ECLAMPSIA
• PROM
• POSTTERM
PREGNANCY
• ABRUPTIO PLACENTA
• CHORIOAMNIONITIS
• MEDICAL
CONDITIONS-DM,
HEART DISEASE,
RENAL DISEASE,
CHRONIC HTN ETC
FETAL
 IUFD
 Fetal anomaly
incompatible with
life
 Severe IUGR
 Rh isoimmunization
 Macrosomia

5. CONTRAINDICATIONS
➢SEVERE DEGREE CPD
➢MAJOR DEGREE PLACENTA
PRAEVIA
➢TRANSVERSE LIE
➢PREVIOUS CLASSICAL CS
➢PREVIOUS>= 2 LSCS
➢GRAND MULTIPARITY
➢ACTIVE GENITAL HERPES
➢HYPERSENSITIVITY TO INDUCING
AGENT

6. PARAMETERS TO ASSESS PRIOR TO INDUCTION
OF LABOUR
Be sure about the indication for induction
Exclude the contraindications of IOL
Ensure fetal well being
Ensure fetal gestational age and the estimated
weight

7. CERVICAL RIPENING
PRIOR TO INDUCTION
 Cervical ripening is a component of induction of labor
employed when the cervix is unfavorable in order to
facilitate dilatation when labor is established.

8. Bishop’s Score (Modified)
Parameters Score
Cervix 0 1 2 3
Dilatation (Cm) Closed 1-2 3-4 5+
Effacement(%)
Or
Cervical Length
(Cm)
0-30
Or
>4
40-50
or
2-4
60-70
or
1-2
≥ 80
or
<1
Consistency Firm Medium Soft -
Position Posterior Midline Anterior -
Head Station - 3 - 2 - 1, 0 +1, +2

9.  Total Score – 13
 Unfavorable Score – 0-5
 Favorable Score - 6-13
 Bishop score >8 is a good index of inducibility

10. METHODS OF INDUCTION OF LABOUR
 Medical
 Surgical
 Combined

11. Clinical conditions and methods of induction
of labour
Medical Surgical indications
◼Intrauterine fetal death
◼Premature rupture of
membranes
◼In combinations with
surgical induction(ARM)
◼Abruptio placenta
◼Chronic hydramnios
◼Severe pre-eclampsia,
eclampsia
◼In combination with
medical induction
◼To place scalp electrode
for electronic fetal
monitoring

12. MEDICAL INDUCTION:
 Prostaglandins(PGE2, PGE1, PGF2)
 Oxytocin
 Mifepristone

13. SURGICAL INDUCTION
 METHODS:
 Artificial rupture of the membranes
(ARM)
 Stripping the membranes

14. Artificial rupture of the
membranes
 Amniotomy is the artificial rupture of the fetal
membranes resulting in drainage of liquor.
 ARM is performed to induce labour when the cervix
is favorable or during labour contraction.
 It is carried out during a vaginal examination using
an amnihook.