The rate of induction of labor has continued to trend upward. Regardless of whether labor is induced or spontaneously occurs, the goal is vaginal birth.
2. OUTLINE
• INTRODUCTION
• INDICATIONS & CONTRAINDICATIONS
• PREREQUISITES
• CERVICAL RIPENING
• METHODS OF INDUCTION OF LABOUR
• COMPLICATIONS
• CONCLUSION
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3. INTRODUCTION
• INDUCTION OF LABOUR IS THE ARTIFICIAL INITIATION OF
UTERINE CONTRACTION AFTER THE AGE OF VIABILITY IN A
PREGNANT WOMAN WITH INTACT MEMBRANES WITH THE AIM
TO ACHIEVE VAGINAL DELIVERY.
• THE RATE OF INDUCTION OF LABOR HAS CONTINUED TO
TREND UPWARD. REGARDLESS OF WHETHER LABOR IS
INDUCED OR SPONTANEOUSLY OCCURS, THE GOAL IS VAGINAL
BIRTH. 3
5. • PREVIOUS INTRAUTERINE FETAL DEATH AT TERM
• CHORIOAMNIONITIS
• PREMATURE RUPTURE OF MEMBRANE
• PREVIOUS PRECIPITATE LABOUR
• SEVERE ABRUPTIO PLACENTAE WITH DEAD FETUS
• ELDERLY PRIMIGRAVIDA AT TERM
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9. PREREQUISITES
• VALID INDICATION
• INFORMED CONSENT
• FETAL MATURITY ASSESSMENT
• PELVIC ASSESSMENT
• EXCLUDE ALL CONTRAINDICATIONS TO VAGINAL DELIVERY
• ADEQUATE STAFF FOR INDUCTION OF LABOUR
• ADEQUATE KNOWLEDGE OF INDUCTION PROCEDURE
• PRE-INDUCTION CERVICAL STATUS MUST BE FAVOURABLE
BASED ON BISHOP SCORE 9
10. CERVICAL RIPENING
• CERVICAL RIPENING IS AN IMPORTANT FIRST COMPONENT OF LABOUR
INDUCTION.
• IT INVOLVES SOFTENING AND REMODELING OF THE CONNECTIVE TISSUE
COMPONENTS OF THE CERVIX. RIPENING OFTEN STIMULATES LABOUR.
• THE BISHOP SCORING SYSTEM IS USED TO DETERMINE FAVORABLE OR
UNFAVORABLE CERVIX.
• IF THE CERVIX IS DEEMED UNFAVORABLE, USUALLY DEFINED AS BISHOP SCORE
LESS THAN OR EQUAL TO 6, CERVICAL RIPENING IS INDICATED.
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22. CONCLUSIONS
INDUCTION OF LABOR IS A VIABLE THERAPEUTIC OPTION FOR APPROPRIATELY
SELECTED PATIENTS; HOWEVER, THE BENEFITS OF CONTINUING A PREGNANCY
MUST BE OUTWEIGHED BY THE POTENTIAL MATERNAL AND FETAL RISKS
ASSOCIATED WITH THE PROCEDURE
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Stimulation of labour: after rupture of membrane
Augmentation: potentiation of labour that has begun spontaneously
Generally, cervical ripening and induction of labor are on a continuum and not all women undergoing induction of labor need cervical ripening.
Hydrophobic dermatan sulphate is reduced and hyaluronic acid increases with an increased water content of the cervix causing softening and dilatation.
Mechanical methods work by directly causing cervical dilation and also by releasing endogenous prostaglandins and oxytocin
Mechanical methods should be carefully considered in the setting of a low-lying placenta.
The dilators are hydrophilic such that they absorb water and enlarge, which in turn causes the cervix to dilate.
The efficacy of these dilators for induction of labor are mixed.
Complications : Premature rupture of membranes, bleeding, displacement of presenting part, Chorioamnionitis/endometritis, neonatal sepsis
Laminaria inserted just beyond the cervical os
Expanded laminaria causing cervical dilation
Prostaglandin side effects
Uterine hypertonicity or tachysystole
Fetal distress
Nausea and vomiting
PGE1 is cheaper than E2
