INDUCTION OF LABOUR.

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Presentation transcript:

INDUCTION OF LABOUR

DEFINITION Induction of labour means deliberate termination of pregnancy beyond 28 weeks (Period of viability) by any method which aims at initiation of labour and a vaginal delivery.

Fetal Maternal Combined Indications Fetal Maternal Combined Post maturity History of IUD DM IUGR Rh-isoimmunisation Unstable lie IUD Chronic polyhydramnios Congenital malformations Maternal Pre –eclampsia Minor degree of placenta praveia Abruptio placenta PROM Chronic HTN Chronic renal disease Combined

CONTRAINDICATIONS Contracted pelvis and CPD Persistent malpresentation Pregnancy with previous caesarean section Elderly primigravida Heart disease High risk pregnancy with compromised fetus Pelvic tumour

SUCCESS OF INDUCTION depends on Period of gestation Case profile Sensitivity of the uterus Pre induction scoring

METHODS OF INDUCTION Medical Drugs used oxytocin, prostaglandins LRM AROM HRM Surgical Stripping of membranes Combined

Merits and demerits of each method Prostaglandin Advantages Effective method in IUD or cases with unfavourable cervix No antidiuretic effect Drawbacks More systemic side effects when used orally or I/V Hyper stimulation

OXYTOCIN Advantages Wider availability Less systemic side –effects HAZARDS OF AROM Cord prolapse Uncontrolled escape of amniotic fluid Injury to cervix or presenting part Rupture of vasapraevia leading to fetal blood loss. Amnionitis

Injury to the placenta Accidental injury to the uterine wall Injury to the fetal parts especially eye. Displacement of presenting part Intra –ammotic infection Longer induction – delivery interval compared to LRM

SCHEME OF INDUCTION PROTOCOL CX – favourable Surgical Medical CX – unfavourable Oxytocin or prostaglandin E2 Prostaglandin more effective LRM HRM APH Severe PIH Eclampsia Ch. Polyhydramnios Combined (common) Prostaglandin E2 gel/ Oxytocin infusion Cervix –ripe LRM + OXYTOCIN

NURSING CARE Technique of oxytocin administration Indications for stopping the drip Nursing measures Consent, explain to the patient Monitoring Supervision and recording of findings Pain relief

Observation Rate of flow Uterine contractions FHR Progress of labor Maternal conditions - Vital signs - Urine for ketoacidasis - Intake and output chart - Watch for prolapse of cord