Dr. MSc. Raul Hernandez Canete INDUCTION OF LABOUR Dr. MSc. Raul Hernandez Canete

Induction of labour: An intervention designed to artificially initiate uterine contractions leading to progressive dilatation and effacement of the cervix and birth of the baby. This includes both women with intact membranes and women with spontaneous rupture of the membranes but who are not in labour.

Is indicated when the risk of continuing the pregnancy are felt to be greater than the risks of ending the pregnancy. The decision is often difficult, particularly at preterm gestations, and many factors, including the availability of neonatal facilities, need to be considered Labour should no be induced unless there are not good medical reasons to do so.

Induction is different to Augmentation: Induction: refers to the process of starting labour and can only be applied to a mother who is not already in labour. Augmentation: describes the process of accelerating labour after it has already started.

Indications: Fetal indications: Post-term pregnancy. Intrauterine growth retardation. Intrauterine fetal death. Rh- isoimmunization. Gross congenital anomalies. PROM

Indications: Maternal indications: Preeclampsia Deteriorating medical conditions (cardiac or renal disease, severe systemic lupus erythematosus) Diabetes Mellitus

Contraindications: CPD Placenta Praevia Uterine scar Transverse lie

Before induction: The gestation should again be confirmed The presentation checked Rule out contraindications (e.g. placenta praevia) History of uterine scar. Parity

Cervical favourability 1 2 3 >=5 3-4 1-2 Dilatation of cervix (cm) Soft Medium Firm Consistency of cervix <0.5 1-0.5 2-1 >2 Length of cervical canal (cm) Anterior Central Posterior Position of cervix below 1or 0 2 3 Station (cm above ischial spines)

The decision about which technique is the most appropriate depends on the favourableness of the cervix as assessed by Bishop’s scoring system: Cervix unfavourable score < 6 Cervix favourable score > 6

Methods of cervical ripening: Prostaglandin Balloon catheter Others: Laminaria, Relaxin.

Methods of Induction of Labour: Surgical methods: Amniotomy (ARM) Membrane sweep Pharmacologic methods: Oxytocin Prostaglandin (25 mcg)

Care during induction of labour Wherever induction of labour occurs, facilities should be available for continuous uterine and FHR monitoring Assess fetal wellbeing Assess maternal conditions

Complications: For the mother: Failure of induction, prolonged labour, abruption placental, uterine rupture, cervical tears, infection, PPH. For the fetus: prematurity, cord prolapse, fetal distress, infection, intraventicular hemorrhage.