This document discusses the induction of labor. It begins by defining induction of labor as artificially initiating uterine contractions before their spontaneous onset, leading to cervical dilation and delivery. Common indications for induction include prolonged pregnancy past 41 weeks, maternal health conditions, and fetal health concerns. A full assessment of dates, fetal position, and cervical condition is recommended before induction. Common methods discussed include membrane sweeping, prostaglandins administered vaginally or orally, misoprostol, and oxytocin infusion. Risks of failed induction or complications are also outlined.

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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