INDUCTION
OF LABOUR
Induction of labour means inducing a
quiescent uterus to get into the process of
labour.
FACTORS INFLUENCING SUCCESS OF AN
INDUCED LABOUR
[Link]
[Link] cervical score
[Link] to term
[Link] or method used
BISHOP SCORE
Parameter 0 1 2 3
closed 1-2 3-4 >/=5
Dilatation
>4/0-30% 2-4/40-60% 1-2/60- 1-2/
Length(cm) 70% >80%
+1/+2
Station -3 -2 -1/0
Consistency firm medium soft
posterior midposition anterior
Cervical
position
The Bishop score and the modified bishop
score can be used to evaluate the
condition of cervix and the station of
presenting part,as a prognostic index for
success of induction
INDICATIONS FOR INDUCTION OF LABOUR
Pregnancy induced hypertension:
.Mild preeclampsia:37 weeks
.Severe preeclampsia:34 weeks
.Eclampsia/HELP syndrome:immediately
Pemature rupture of
membrane:immediately
Preterm rupture of membrane:34weeks
Posttrem :immediately
Abrupto placenta :immediately
Chorioamnionitis:immediately
Olygohydramnios:36weeks
Gestational diabetes:>/=39 weeks
In RH isoimmunisation
.Severe anemia:34 weeks
.PSV<1.5 mom/antibody titre less than
1:16 then 37 weeks
.Indirect coombs test negative:40 weeks
Status of cervix should be checked before
induction of labour using bishops score.
CONTRAINDICATIONS
.Gross degrees of contracted pelvis and
cephalopelvic disproportion
.Transverse or oblique lie
.Placenta praevia or vasa pravia
.High risk pregnancy with severely
compromised fetus
.Pathological fetal heart tracing
.Pregnancy following classical caesarean
section
.Presence of active genital herpes
CERVICAL RIPENING
All unfavourable or unripe cervices need
an agent first to ripen the cervix and then
induction is to be [Link]
ripening is the process that culminates in
softening and distensibility of the cervix
thus facilitating labour and delivery.
METHODS OF CERVICAL
RIPENING AND INDUCTION
[Link] METHODS
.Stripping of the membranes
.Foley catheter
.Transcervical balloon catheter
.Extra amniotic saline instillation
.Mechanical dilators like
dilapan,lamicel
.Amniotomy
[Link] METHODS
.ProstaglandinE2 (Dinoprostone)
.ProstaglandineE1(Misoprostone)
.Antiprogesterones like mifepristone
.Oxytocin
.Relaxin and nitric acid donors
COMPLICATIONS
.Hyperstimulations leading to fetal
distress and rupture uterus
.Traumatic postpartum
haemorrhage,especially with the use of
prostaglandins
.Infections
.Iatrogenic prematurity
.Dysfunctional labours and failed
inductions
.Increased caesarean section rates
.Nausea,vomiting and diarrhoea
exclusively with oral prostaglandins
.Water intoxication with oxytocin due
to the mild antidiuretic effect
.Amniotic fluid embolism
MONITORING INDUCED LABOUR
Continous cardiotocography
monitoring is recommended whenever
oxytocin is [Link] not fetal heart rate
and contactions are to be checked
every 15 min in the first stage and
every 5 min in the second stage after a
[Link] titration of oxytocin
driprates is essential using an infusion
pump.
FAILED INDUCTION
An induced labour is said to be failed
when the women has not entered the
active phase of labour despite
induction.
Failed induction should only be
diagnosed after oxytocin
administration and ruptured
membranes.
In nulliparous women failed induction
may occur in about 25% if the cervix is
unfavourable.
The incidence of caesarean section in
induced labour varies from 15-30%.
THANKYOU