induction of labor bya.malibary,m.d.. induction the process whereby labor is initiated artificially

Induction of LaborInduction of Labor

ByBy

A.MALIBARY,M.D.A.MALIBARY,M.D.

InductionInduction

The process whereby labor The process whereby labor is is initiatedinitiated artificially artificially

AugmentationAugmentation

The artificial stimulation of The artificial stimulation of labor that has been labor that has been startedstarted spontaneouslyspontaneously

Indication for InductionIndication for Induction

MaternalMaternal

FetalFetal

MaternalMaternal

IUFDIUFDPolyhydramniosPolyhydramniosPETPETHeart diseasesHeart diseasesD.MD.M

FetalFetal

Prolonged PregnancyProlonged PregnancyIUGRIUGRRh isoimmunizationRh isoimmunizationUnexplained IUD in prior pregnancyUnexplained IUD in prior pregnancyPROMPROMChorioamnionitisChorioamnionitisMalformationMalformationOthersOthers

CombinedCombined

Pregnancy-induced hypertensionPregnancy-induced hypertension

Chronic renal diseasesChronic renal diseases

Bad obstetric historyBad obstetric history

APHAPH

ContraindicationsContraindications

--Contracted pelvisContracted pelvis--Major degree of CPDMajor degree of CPD

--Pregnancy following classical C.sectionPregnancy following classical C.section--Pregnancy following repair of a vesico-Pregnancy following repair of a vesico-

vaginal fistulavaginal fistula--Overdistended uterusOverdistended uterus

--Preterm fetus without lung maturityPreterm fetus without lung maturity--Acute fetal distressAcute fetal distress

--Abnormal presentationAbnormal presentation--Presence of active herpetic genital lesionsPresence of active herpetic genital lesions

Assessment for InductionAssessment for Induction

Prior to induction of labor the following Prior to induction of labor the following have to be considered carefullyhave to be considered carefully

--The period of gestation and edd needs The period of gestation and edd needs careful checkingcareful checking

--Assessment of any CPD is importantAssessment of any CPD is important--Fetal malpresentationFetal malpresentation

--Cervical assessment ( Bishop’s score )Cervical assessment ( Bishop’s score )--Station of presenting partStation of presenting part

All the parameters are not equally All the parameters are not equally importantimportant Cervical dilatationCervical dilatation and and station of thestation of the presenting partpresenting part are more important than are more important than the rest of the parametersthe rest of the parametersHigher scoresHigher scores are commonly referred to as are commonly referred to as a a ‘Ripe’ cervix‘Ripe’ cervixThe The ripenessripeness of the cervix is linked to of the cervix is linked to easiereasier inductioninduction with shorter interval with shorter interval between induction and the onset of laborbetween induction and the onset of labor

The The unripeunripe cervix does not cervix does not preclude induction ; it is only preclude induction ; it is only indicates a indicates a longer latent longer latent phasephase following induction following induction

Method of InductionMethod of Induction

OxytocinOxytocin

Discovered by Discovered by du Vagneaud in America in du Vagneaud in America in 19531953

OctapeptideOctapeptide

Synthetic Oxytocin preparations, Synthetic Oxytocin preparations, Syntocinon and PitocinSyntocinon and Pitocin are commonly are commonly usedused

Syntocinon is avaiable in Syntocinon is avaiable in injectionsinjections

ActionsActions

Uterus Uterus Rhythmical Rhythmical contractionscontractions

BrestBrest StimulationStimulation

Cardiovascular systemCardiovascular system

Water retensionWater retension

Dose Dose 10 units10 units of Oxytocin in 1000 of Oxytocin in 1000 ml in ml in 5%5% DextroseDextrose Starting Dose Starting Dose 1 mU/ min1 mU/ minIV IV infusioninfusionInfusio Infusio pumppump

Important PointImportant PointClose and Constant supervision for Close and Constant supervision for uterine contractions; fetal heart uterine contractions; fetal heart rate ; progress of laborrate ; progress of labor

Complications of SyntocinonComplications of Syntocinon

Incoordinate uterine Incoordinate uterine action;action;hyperstimulationhyperstimulationFetal Fetal hypoxiahypoxiaUterine Uterine ruptureruptureWater Water intoxicationintoxicationUterine Uterine fatiguefatigue;PPH;PPH

ProstaglandinsProstaglandins

Extract of human seminal fluid Extract of human seminal fluid was observed to possess was observed to possess smooth muscle stimulation smooth muscle stimulation and blood pressure lowering and blood pressure lowering activity by von Euleractivity by von Euler

Routes of administrationRoutes of administration

OralOral Vaginal-Gel or PessaryVaginal-Gel or PessaryLocal via catheterLocal via catheter

Intravenous PGF 2Intravenous PGF 2@ @ IntramuscularIntramuscular

ContraindicationsContraindications

Bronchial asthmaBronchial asthmaEpilepsyEpilepsyHypersensitivityHypersensitivityRenal diseaseRenal diseaseHypertensionHypertensionPeptic ulcerPeptic ulcer

Amniotomy (ARM)Amniotomy (ARM)WidelyWidely used methodology used methodologyEasyEasyNo anaesthesia or analgesiaNo anaesthesia or analgesiaSafeSafe Cord prolapseCord prolapseChorioamnionitisChorioamnionitis

Risk of InductionRisk of Induction

FailureFailurePrematurityPrematurityAbnormal uterine actionAbnormal uterine actionInfectionInfectionMaternal exhaustionMaternal exhaustionFetal hypoxiaFetal hypoxiaAmniotic fluid embolismAmniotic fluid embolism

Result of InductionResult of Induction

The success of induction can not The success of induction can not really be measured by really be measured by the the favorable outcome of a vaginal favorable outcome of a vaginal deliverydelivery, The time interval , The time interval between induction and the onset between induction and the onset of labor is more realistic goal and of labor is more realistic goal and this mainly depend onthis mainly depend on::

Proximity to termProximity to term

Condition of the cervixCondition of the cervix

Method of inductionMethod of induction

Station of PPStation of PP

Amount of liquor drainedAmount of liquor drained

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THANK UTHANK U9/20079/2007