Induction of labor involves artificially initiating labor through mechanical or medical means. It is considered when the risks of continuing the pregnancy outweigh the risks of delivery. The cervix should be favorable with a Bishop score of at least 6. For an unfavorable cervix, ripening agents like balloons or misoprostol are used. Oxytocin and misoprostol are common medical induction agents. Indications include post-term pregnancy, low amniotic fluid, preeclampsia, and diabetes. Contraindications include previous C-sections and fetal issues. Women receiving induction agents must be monitored closely. Higher chances of success include multiparity, ruptured membranes, and lower fetal weights. Prol

1. Induction of labor

2. Introduction
• Induction is artificial initiation of labor
• The risk of continuing pregnancy vs the risk of delivery
• The cervix should be favorable (unfavorable cervix is a
bishop score of <6)

3. Unfavourable cervix / bishop score <6
• Ripening with mechanical balloon
• Medical ripening
with 25ug misoprostol every 6 hours for 3 doses.
Dinoprostol

5. • Different mechanisms
• Mechanical
• Insertion of ballon catheter
• Hygroscopic cervical dilators
• Medical
Oxytocin
Misoprostol
Ergometrine

6. Indications for induction
• Post term pregnancy
• Oligohydramnios
• Placental abruption
• Prolonged rupture of membrane
• Preeclampsia or eclampsia
• Diabetes
• Intra amniotic infections

7. Contraindications
• Previous c/s scar
• Previous uterine surgery like myomectomy or uterine repair
• Macrosomia
• Active genital herpes
• Fetal distress
• Malpresentation like transverse lie and breech presentation or
malposition like brow presentation
• Placenta previa
• Twin pregnancy

8. Preinduction patient assessment
• Check Gestational age and Estimated fetal weight
• Fetal presentation
• Status of the cervix
• FHR

9. Dose of oxytocin
• For primigravida. 2.5IU in 500 ml of NS
• For multipara....1.25 IU in 500ml of NS
• Slowly increase the Drops every 20 minutes starting from 20 Drops per minute to
80 Drops
• Follow fetal heart beat every 20 minutes
• Count uterine contractions every 20 minutes
• More than 5 contractions lasting for >30 minutes...tachysystole, consult with the
Dr. to decrease the drops

10. Misoprostol
• Misoprostol 200 mcg will be dissolved in 200 mL of tap water, constituting a
solution of 20 mcg in 20 mL.
• This solution may be used for up to 48 hours.
• An initial dose of 20 mcg (20 mL measured in a syringe) will be given by mouth,
and the time of the first dose recorded.
• The same dose will be repeated every hour for 3 hours (total of 4 doses).
• Patients may ambulate and take oral fluids and light foods

11. • The patient will be monitored with the fetal heart tracing and cardiotocogram
(CTG) for 20 minutes after receiving the medication.
• If fetal tolerance has been assured, then the patient can be off the monitor for 20
minutes.
• The patient is then placed back on the fetal heart tracing and CTG 20 minutes
prior to the next dose.

12. • If the FHR remains reassuring, and regular uterine contractions (3 contractions
every 10 minutes lasting at least 30 seconds) have not ensued after 4 hours:
• the dose may be increased to 40 mcg (40 mL) every 2 hours until active labor is
established

13. Higher chance of successful induction
•Multiparity
•Ruptured membranes
•Lower body mass index (BMI)
•Taller height
•Lower estimated fetal weight
•Absence of comorbidities associated with placental insufficiency (eg, preeclampsia)

14. Important points
• Women receiving oxytocin, misoprostol or other prostaglandins should never be
left unattended.
• Wherever possible, induction of labour should be carried out in facilities where
caesarean sections can be performed.
• Oxytocin rest” or break – routine stopping oxytocin and then restarting the
infusion after a period of time is not recommended

15. Prolonged labor
Most common cause Is poor uterine contraction
Prolonged LFSOL
> 20 hours for primiGravida
> 14 hours in multigravida
Active first stage of labor
Protracted dilation
<1.2 cm per hour multi
<1.5cm per hour in primi
Arrest of dilation
No change in dilation after 4 hours

16. Questions??