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

2. 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.

3. 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.

4. 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.

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

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

7. Contraindications:
CPD
Placenta Praevia
Uterine scar
Transverse lie

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

9. Cervical favourability1 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)

10. 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

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

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

13. 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

14. 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.