1. ประธานราชวิทยาลัยสูตินรีแพทย์แห่งประเทศไทย
Misoprostol for IOL
ศ. ภิเศก ลุมพิกานนท์
ประธานราชวิทยาลัยสูตินรีแพทย์แห่งประเทศไทย
Vice President, AOFOG
07/12/61
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2. Pisake Lumbiganon, RTCOG
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3. Pisake Lumbiganon, RTCOG
07/12/61
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4. Indications for Induction of labour
Women who are known with certainty to have reached 41 weeks (40 weeks plus seven days or more) of gestation;
Women with prelabour rupture of membranes at term (gestational age of 36 weeks plus seven days or more);
Women with severe pre-eclampsia at a gestational age when the fetus is not viable or unlikely to achieve viability within one or two weeks;
Women with pre-eclampsia or gestational hypertension at term, or earlier as clinically indicated;
07/12/61
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5. Indications for Induction of labour
Women with vaginal bleeding at term, or earlier as clinically indicated;
Women with chorioamnionitis at term, or earlier as clinically indicated;
Women with fetal growth restriction at term, or earlier as clinically indicated;
Women with a dead or anomalous fetus.
07/12/61
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6. IOL is not recommended for
Women with an uncomplicated pregnancy and gestational age of less than 41 weeks.
If gestational diabetes is the only abnormality, but it is well controlled, do not induce labour before 41 weeks of gestation.
If suspected fetal macrosomia at term is the only indication, do not induce labour.
07/12/61
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10. Prostaglandins for IOL
Prostaglandin E2 is available in several forms (3 mg pessary or 2–3 mg gel). The prostaglandin is placed high in the posterior fornix of the vagina and may be repeated after six hours if required.
Misoprostol is a synthetic analogue of prostaglandin E1. It is highly effective in cervical ripening during induction of labour.
07/12/61
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Monitoring during IOL
Monitor and record maternal and fetal status every 30 minutes.
Monitor and record the number of contractions in a 10-minute period and their duration in seconds every 30 minutes.
Assess the progress of labour by:
measuring changes in cervical effacement and dilatation during the latent phase;
measuring the rate of cervical dilatation and fetal descent during the active phase and recording the findings on the partograph;
assessing further fetal descent during the second stage of labour.
07/12/61
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14. Pisake Lumbiganon, RTCOG
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If any contraction lasts longer than 60 seconds, or if there are more than five contractions in 10 minutes, manage as hyperstimulation
07/12/61
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16. Management of Hyperstimulation
Stop the infusion.
Remain with the woman until normal uterine activity is achieved.
Position the woman on her left side (left lateral position).
Assess the fetal heart rate:
If the fetal heart rate is normal (between 100 and 180 beats per minute), observe for improvement in uterine activity and monitor the fetal heart rate.
If the fetal heart rate is abnormal (less than 100 or more than 180 beats per minute),
manage for fetal distress and
relax the uterus using betamimetics: terbutaline 250 mcg IV slowly over five minutes OR salbutamol 10 mg in 1 L IV fluids (normal saline or Ringer’s lactate) at 10 drops per minute.
07/12/61
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07/12/61
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