1. INDUCTION OF LABOUR

2. DEFINITION
Artificial stimulation of uterine contractions before spontaneous onset of labour with the purpose of accomplishing successful vaginal delivery

3. INDICATIONS MATERNAL FETAL Preeclampsia, eclampsia PROM Postterm preg
Abruptio placenta
Chorioamnionitis
Medical conditions-DM,Heart ds, Renal ds,Chr. HT etc
FETAL
IUFD
Fetal anomaly incompatible with life
Severe IUGR
Rh isoimmunisation
Macrosomia

4. CONTRAINDICATIONS Severe degree CPD Major degree placenta praevia
Transverse lie
Previous classical CS,Myomectomy
Previous>= 2 LSCS
Grand multiparity
Active genital herpes
Hypersensitivity to inducing agent

5. RISKS OF INDUCTION Failure leading to CS Uterine hyperstimulation
Fetal distress,death
Rupture uterus
Intrauterine infection,sepsis
Iatrogenic delivery of preterm infant
Precipitate/dysfunctional labour
Inc. risk of operative vaginal delivery
Inc. risk of birth trauma
Inc. risk of PPH

6. PREREQUISITES Establish indication clearly Informed consent
Conformation of gestational age
Assessment of fetal size & presentation
Pelvic assessment
Cervical assessment (BISHOPs score)
Availability of trained personnel

7. MOD. BISHOPS SCORE SCORE 1 2 3 DILATATION 1-2 3-4 >4 EFFACEMENT1 2 3
DILATATION
1-2
3-4
>4
EFFACEMENT
0-30%
40-50%
60-70%
>80%
STATION -3 -2
-1/0
+1,+2,+3
CONSISTENCY
firm
medium
soft
POSITION
posterior
mid
anterior

8. METHODS OF INDUCTION CHEMICAL NATURAL MECHANICAL NONHORMONAL
Herbs,evening primrose oil
Homeopathic prep
Enemas
Castor oil
HORMONAL
Oxytocin
Prostaglandins –PGE2,Misoprostol
Relaxin
Nitric oxide donors
mifepristone
NATURAL
Breast/nipple stimulation
Sexual intercourse
Membrane stripping
Amniotomy
Acupuncture/acupressure
MECHANICAL
Balloon catheters
Lamineria tents
Synthetic osmotic dilators