1. INDUCTION OF LABOUR

2. DEFINITION
Induction of labour means deliberate termination of pregnancy beyond 28 weeks (Period of viability) by any method which aims at initiation of labour and a vaginal delivery.

3. Fetal Maternal Combined Indications Fetal Maternal Combined
Post maturity
History of IUD DM
IUGR
Rh-isoimmunisation
Unstable lie
IUD
Chronic polyhydramnios
Congenital malformations
Maternal
Pre –eclampsia
Minor degree of placenta praveia
Abruptio placenta
PROM
Chronic HTN
Chronic renal disease
Combined

4. CONTRAINDICATIONS
Contracted pelvis and CPD
Persistent malpresentation
Pregnancy with previous caesarean section
Elderly primigravida
Heart disease
High risk pregnancy with compromised fetus
Pelvic tumour

5. SUCCESS OF INDUCTION depends on
Period of gestation
Case profile
Sensitivity of the uterus
Pre induction scoring

6. METHODS OF INDUCTION
Medical
Drugs used oxytocin, prostaglandins
LRM
AROM HRM
Surgical
Stripping of membranes
Combined

7. Merits and demerits of each method
Prostaglandin
Advantages
Effective method in IUD or cases with unfavourable cervix
No antidiuretic effect
Drawbacks
More systemic side effects when used orally or I/V
Hyper stimulation

8. OXYTOCIN
Advantages
Wider availability
Less systemic side –effects
HAZARDS OF AROM
Cord prolapse
Uncontrolled escape of amniotic fluid
Injury to cervix or presenting part
Rupture of vasapraevia leading to fetal blood loss.
Amnionitis

9. Injury to the placenta
Accidental injury to the uterine wall
Injury to the fetal parts especially eye.
Displacement of presenting part
Intra –ammotic infection
Longer induction – delivery interval compared to LRM

10. SCHEME OF INDUCTION PROTOCOL
CX – favourable
Surgical
Medical
CX – unfavourable
Oxytocin or prostaglandin E2
Prostaglandin more effective
LRM
HRM
APH
Severe PIH
Eclampsia
Ch.
Polyhydramnios
Combined
(common)
Prostaglandin E2 gel/ Oxytocin infusion
Cervix –ripe
LRM + OXYTOCIN

11. NURSING CARE
Technique of oxytocin administration
Indications for stopping the drip
Nursing measures Consent, explain to the patient
Monitoring
Supervision and recording of findings
Pain relief

12. Observation
Rate of flow
Uterine contractions
FHR
Progress of labor
Maternal conditions
- Vital signs
- Urine for ketoacidasis
- Intake and output chart
- Watch for prolapse of cord