Induction of Labour

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Induction of Labour

  1. 1. INDUCTION OF LABOUR www.doctor.sd
  2. 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) www.doctor.sd
  3. 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 www.doctor.sd
  4. 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 www.doctor.sd
  5. 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 www.doctor.sd
  6. 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 www.doctor.sd
  7. 7. Medical Interventions 1- Mechanical  Membrane sweeping  Hygroscopic and mechanical dilators  Extra-amniotic infusion of saline  Amniotomy (ARM) www.doctor.sd
  8. 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 www.doctor.sd
  9. 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 www.doctor.sd
  10. 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 www.doctor.sd
  11. 11. Complications of induction of labour  Failed induction  Cord prolapse  Abruption  Hyponatremia  Uterine hyperstimulation  Post-partum hemorrhage  Prematurity  Hyperbillirubinemia and jaundice www.doctor.sd
  12. 12. Special cases  Induction following C/S  Grandmutiparae www.doctor.sd

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