1. Induction of labor (IOL)
is the process whereby the uterine muscle contracts and retracts leading to effacement and dilatation of the cervix, the birth of the baby, expulsion of the placenta and membranes, and the control of bleeding

2. -IOL:
is an intervention to initiate the process of labour described above by artificial means and involves the use of prostaglandins, ARM (amniotomy), intravenous oxytocin, or any combination of these

3. It is the term used when initiating this process in pregnancies from 24 weeks' gestation, the legal definition of fetal viability
,Where labour is being induced a full assessment must be made to ensure that any intervention planned will confer more benefitfimore than risk for both mother and baby.

4. Indications for IOL - hypertension, Diabetes
, fetal growth restriction or
macrosomia.
- There is no guarantee IOL will result in a vaginal birth or positive outcome for mother and/or her baby.

5. I ndica t io ns f o r induct io n o f la bo ur
Maternal
Prolonged pregnancy
This is the commonest reason for induction of labour to avoid risk of perinatal mortality and morbidity
Hypertension, including pre-eclampsia

6. Diabetes –The risk of fetal macrosomia is increased where diabetic control is poor.
In women with pre- existing type 1 and type 2 diabetes, the risk of adverse perinatal outcome elective IOL is offered after 38 weeks' gestation

7. Prelabour rupture of membranes – the longer the interval between membrane rupture and birth of the baby increases the risk of infection to mother and fetus. For the majority of women spontaneous labour will commence within 24 hours of rupture of membranes but women should be offered the choice of IOL after 24 hours or expectant management

8. Maternal request – this may be for psychological or social reasons.
. IOL may be considered from 40 weeks

9. Fetal
Fetal death –
Fetal anomaly not compatible with life.

10. So m e co nt r a indica t io ns f o r induct io n o f la bo ur
Placenta praevia
Transverse lie or compound presentation
HIV-positive women not receiving any anti- retroviral therapy or women on any anti- retroviral therapy
Active genital herpes

11. Cord presentation or cord prolapse when vaginal birth is not imminent
Known cephalo-pelvic disproportion (CPD)
Severe acute fetal compromise

12. Methods of induction -For an induction to be successful;
1- the cervix needs to have undergone the changes that will ensure the uterine contractions are effective in the progressive dilatation and effacement of the cervix,
2-descent of the presenting part
3-the birth of the baby.
-The cervix is said to be ripe when it has undergone these changes.
-The Bishop score, devised is the means by which the ripeness of the cervix is assessed using a scoring that examines four features of the cervix and the relationship of the presenting part to the ischial spines.

13. Each of these five elements is scored between 0 and 3 on vaginal examination (VE). The scoring system has been modifed and it is this version that is used in contemporary practice
Whilst a score of les 6 is considered to be unfavourable, a score of 8 or more suggests a greater probability of a vaginal birth, similar to that when the onset of labour is spontaneous

14. A ripe or favourable cervix is one that for the purpose of IOL is more compliant, offering less resistance as the contraction and retraction of the myometrium forces the presenting part down

15. Modified Bishop's pre-induction pelvic scoring system

16. -A VE to assess the cervix with skilled person
Transvaginal ultrasound assessment of cervical length was found to be superior to the Bishop's score in predicting the success of IOL .but currently VE remains the most common method of cervical assessment for IOL.

17. Cervical membrane sweep
-A cervical membrane sweep (CMS), offered to nulliparous women at the 40- and 41-week antenatal examination and to parous women at the 41-week review.

18. -It is commonly undertaken by a doctor or midwife experienced in the practice and has been shown to reduce the need for further methods to induce labor
be aware if the woman is to be able to make an informed choice.

19. Some women may find the procedure uncomfortable or painful and they may experience vaginal spotting and abdominal cramps
safe in that it did not lead to prelabour rupture of membranes, bleeding or maternal or neonatal infection, for some women it did cause significant discomfort and in their study was not found to reduce the need for IOL.

20. suggest the possible benefits in terms of a reduction in more formal induction methods need to be weighed against the discomfort of the VE and other adverse effects of bleeding and irregular contractions not leading to labour.
-CMS at 40/41 weeks is to avoid prolonged pregnancy and is not meant for high-risk cases.