Induction of labour

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Presentation Transcript

Slide 1: 

Induction of labour

Slide 2: 

It is the initiation of uterine contraction , after the period of viability for the purpose of vaginal delivery Induction

Indications : 

Indications Postmaturity Intrauterine fetal death Premature rupture of membranes Preeclampsia- eclampsia Antepartum Hemorrhage Congenital anomalies of fetus Chronic hydramnios Growth restriction Multiple Pregnancy Stabilising Induction History of precipitated labour

Prerequisites : 

Prerequisites Exclude contracted pelvis & CPD Exclude malpresentation Ensure fetal lung maturity & estimated fetal weight Ensure fetal well being Assess Bishops Score

Bishops score ( Modified) : 

Bishops score ( Modified) TOTAL SCORE =13,FAVOURABLE =6-13,UNFAVOURABLE=0-5

Medical induction : 

Medical induction Dinoprostone Tablets , Gels - 0.5 mg Collagenolytic = Cervical ripening Sensitizes myometrium to oxytocin Applied every 6 hrly for 3 - 4 doses Prostaglandins Oxytocin Mifepristone Prostaglandins PGE 2

Misoprostol ( PGE 1) : 

Misoprostol ( PGE 1) Tablets – 100,200 mcg Vaginal 25 mcg 3 hourly max. 4 doses Oral 50 mcg 4hourly Side effects Tachysystole Fetal distress Uterine rupture

Mifepristone : 

Mifepristone Blocks both progesterone & glucocorticoid receptors 200 mg vaginally daily for 2 days

Oxytocin : 

Oxytocin Receptors are more in late pregnancy & labour More receptors in the fundus Short half life ( 3-4 minutes) IV infusion / Nasal solution 1 ampoule = 1 ml = 5 units

Slide 11: 

2 units oxytocin in 500 ml 5% D Start @ 15 drops /min ( 4 miu / min ) Escalate at every 20 min (if there is no adequate response) Upto 16 – 32 miu s / min

Oxytocin Vs Prostaglandins : 

Oxytocin Vs Prostaglandins Cheaper Needs refrigeration IV infusion needed Less effective in Low bishop score IUFD Less GA Reversible uterine hyperstimulation PGE2 Costly PGE2 needs refrigeration Intravaginal/ oral More effective May be irreversible

Surgical induction : 

Surgical induction Can be High rupture of membrane Low rupture of membrane Artificial rupture of membrane

Mechanism : 

Mechanism Separation of membranes Liberation of prostaglandins Stretching of cervix.

Advantages : 

Advantages High success rate Chance to observe amniotic fluid Access to use Scalp electrode place intrauterine catheter scalp blood sampling Control of bleeding in APH Relief of maternal distress in chr. hydramnios

Procedure : 

Procedure Index finger passed through the internal os  Membrane swept free from the lower uterine segment. Kocher forceps introduced along the palmar surface of fingers Membrane over the presenting part is hold  Twisted to tear Some times pushing of the head is needed Colour of liquor , FHR pattern

Hazards of ARM : 

Hazards of ARM Chance of umbilical cord prolapse Amnionitis Irreversible Injury to placenta , cervix , fetal parts Amniotic fluid embolism

It is the digital separation of chorioamniotic membranes from the wall of the lower uterine segment and cervix : 

Stripping the membrane It is the digital separation of chorioamniotic membranes from the wall of the lower uterine segment and cervix Release of prostaglandin Onset of ferguson reflex It also used to make cervix ripe

Indication : 

Indication IUD PROM Abruptio Placentae Chronic hydramnios Scalp electrode placement Medical Surgical

Combined method of induction : 

Combined method of induction Increases success rate Decreases induction delivery interval If head is high up start medical induction then after engagement of head go for surgical method

Slide 21: 

Abruptio placentae ARM Oxytocin

Slide 22: 

Thank you