Induction of Labor ByA.MALIBARY,M.D.

Induction The process whereby labor is initiated artificially

Augmentation The artificial stimulation of labor that has been started spontaneously

Indication for Induction MaternalFetal

MaternalIUFDPolyhydramniosPET Heart diseases D.M

Fetal Prolonged Pregnancy IUGR Rh isoimmunization Unexplained IUD in prior pregnancy PROMChorioamnionitisMalformationOthers

Combined Pregnancy-induced hypertension Chronic renal diseases Bad obstetric history APH

Contraindications -Contracted pelvis -Major degree of CPD -Pregnancy following classical C.section -Pregnancy following repair of a vesico- vaginal fistula -Overdistended uterus -Preterm fetus without lung maturity -Acute fetal distress -Abnormal presentation -Presence of active herpetic genital lesions

Assessment for Induction Prior to induction of labor the following have to be considered carefully -The period of gestation and edd needs careful checking -Assessment of any CPD is important -Fetal malpresentation -Cervical assessment ( Bishop’s score ) -Station of presenting part

All the parameters are not equally important Cervical dilatation and station of the presenting part are more important than the rest of the parameters Higher scores are commonly referred to as a ‘Ripe’ cervix The ripeness of the cervix is linked to easier induction with shorter interval between induction and the onset of labor

The unripe cervix does not preclude induction ; it is only indicates a longer latent phase following induction

Method of Induction Oxytocin Discovered by du Vagneaud in America in 1953 Octapeptide Synthetic Oxytocin preparations, Syntocinon and Pitocin are commonly used Syntocinon is avaiable in injections

Actions Uterus Rhythmical contractions Brest Stimulation Cardiovascular system Water retension

Dose 10 units of Oxytocin in 1000 ml in 5% Dextrose Starting Dose 1 mU/ min IV infusion Infusio pump Important Point Close and Constant supervision for uterine contractions; fetal heart rate ; progress of labor

Complications of Syntocinon Incoordinate uterine action;hyperstimulation Fetal hypoxia Uterine rupture Water intoxication Uterine fatigue;PPH

Prostaglandins Extract of human seminal fluid was observed to possess smooth muscle stimulation and blood pressure lowering activity by von Euler

Routes of administration Oral Vaginal-Gel or Pessary Local via catheter Intravenous PGF Intramuscular

Contraindications Bronchial asthma EpilepsyHypersensitivity Renal disease Hypertension Peptic ulcer

Amniotomy (ARM) Widely used methodology Easy No anaesthesia or analgesia Safe Cord prolapse Chorioamnionitis

Risk of Induction FailurePrematurity Abnormal uterine action Infection Maternal exhaustion Fetal hypoxia Amniotic fluid embolism

Result of Induction The success of induction can not really be measured by the favorable outcome of a vaginal delivery, The time interval between induction and the onset of labor is more realistic goal and this mainly depend on:

Proximity to term Condition of the cervix Method of induction Station of PP Amount of liquor drained

THANK U 9/2007