induction of labour

1. PRESENTED BY:-
ABHILASHA VERMA
M.Sc. Prev.
PRESENTATION
ON
INDUCTION OF LABOUR

2. DEFINITION:
INDUCTION-
“It is defined as artificial stimulation of uterine contraction
before the spontaneous onset of labor with aim of
achieving delivery by any method i.e medical, surgical
and combined methods”
AUGMENTATION-
“Stimulation of spontaneous uterine contractions both in
frequency and intensity, that are considered inadequate
because of failed cervical dilation and fetal descent”

3. INDICATION:
i) Maternal medical complication:
 Pregnancy induced hypertension ( Precelampsia & Eclampsia)
 Diabetes mellitus
 Cholestasis of pregnancy
ii) Postmaturity
iii) Abruptio placentae
iv) IUGR
v) IUFD
vi) PROM
vii) Major congenital abnormalilty
viii) Unstable lie after correction into longitudinal lie

4. CONTRAINDICATION:
I) Contracted pelvis & cephalo-pelvic disproportion.
II) Malpresentation ( Breech, transverse or oblique lie)
III) Previous hysterotomy.
IV) Unexplained vaginal bleeding, vasa previa & placenta previa.
V) Active genital herpes infection.
VI) High risk pregnancy with fetal compromise
VII) Pelvic tumor
VIII) Elderly primigravida with obstetric or medical complication.
IX) Cervical carcinoma.

5. RISKS:
i) Maternal Risk-
•Psychological upset, Failure leading to Cesarean section
•Uterine hyper-stimulation
•Rupture uterus
•Intrauterine infection, Chorio-amnionitis
•Precipitate labor
•Increased risk of operative vaginal delivery
•Increased risk of post partum hemorrhage
•Abruptio Placentae
•APH

6. Fetal Risk:
•Fetal distress .
•Fetal death
•Neonatal sepsis
•Iatrogenic delivery of a preterm infant
•Cord prolapse
•Increased risk of birth trauma
•Hypoxia due to uterine dysfunction.

7. CRITARIA FOR INDUCTION OF LABOR:
i) MATERNAL-
 Confirm maternal indication for induction.
 Review contraindication to vaginal delivery.
 Perform clinical pelvimetery to assess shape and adequacy of pelvis.
 Assess BISHOP score ( Score > 6, favorable)
 Adequate counselling about risks, benefits, alternative of induction of labour.
ii) FETAL-
 Ensure fetal gestational age
 Estimate fetal weight
 Ensure fetal lung maturation status.
 Ensure fetal presentation & lie.
 Confirm fetal wellbeing.

8. BISHOP- SCORING

9. METHOD OF INDUCTION OF LABOR:
MECHANICAL
COMBINEDSURGICAL
MEDICAL

10. MECHANICAL METHODS
i) Hygroscopic dialators
ii) Balloon dialators.

11. iii) MEMBRANE SWEEP

12. MEDICAL METHODS:-
Drugs used are:-
Prostaglandins Oxytocin

13. S.N DRUG NAME TRADE NAME ROUTE DOSES
1 PROSTAGLANDINS i) Cervigel
ii) Dinoripe
iii) Prepidil
Intra Cervical
(Gel form)
Intravaginal gel
form
0.5 mg PGE2
Maximum
dose 1.5 mg/
24 hours.
2.5 mg PGE2
Max. dose
5mg.
2. OXYTOCIN SYNTOCIN IV low dose 1-2
miliUnit/Min
High dose =8
mili unit / min
.

14. SURGICAL METHOD
ARTIFICIAL RUPTURE OF MEMBRANE

15. ARTIFICIAL RUPTURE OF MEMBRANE
• Membranes are ruptured by using a
specialized tool, i.e amnii hook , amnicot to
induce or accelerate labour.
• Mechanism of action-
i) Stretching of cervix
ii) Separation of membrane
iii) Release of prostaglandins
iv) Reduction of amniotic fluid volume.

16. ARTIFECIAL RUPTURE OF MEMBRANE

17. COMBINED METHOD
• Combined mechanical, medical, and surgical
methods are used to increase effecacy of
induction by reducing the induction-delivery
interval.