INDUCTION OF LABOUR

DELIBERATE TERMINATION OF PREGNANCY AFTER 28 WKS OF GESTATION BY ANY METHOD WHICH AIMS AT INITIATION OF LABOUR AND VAGINAL DELIVERY

INDICATIONS
FETAL: 1.POSTMATURITY 2.PAST H/O I U D 3.DIABETES MELLITIS 4.CHRONIC PLACENTAL INSUFFIENCY 5.RH-ISOIMMUNISATION 6.UNSTABLE LIE

INDICATIONS
MATERNAL: 1. IUD 2.CHRONIC POLYHYDROMNIOS 3.CONGENITAL MALFORMATION OF FETUS 4.UNCONTROLLABLE CHOREA GRAVIDARUM

INDICATIONS
COMBINED: 1. PREECLAMPSIA& ECLAMPSIA 2. PLACENTA PRAEVIA 3. PROM 4. CHRONIC HYPERTENSION 5. CHRONIC RENAL DISEASE

ELECTIVE INDUCTION
DELIBERATE

TERMINATION OF PREGNANCY AT TERM FOR THE CONVENIENENCE OF PATIENT OBSTETRICIAN OR HOSPITAL

CONTRAINDICATIONS
1.

2.
3. 4. 5. 6. 7.

CP AND CPD MALPRESENTATION PREVIOUS L S CS ELDERLY PRIMIGRAVIDA HEART DISEASE HIGH RISK PREGNANCY PELVIC TUMOUR

DANGERS

1.
2. 3. 4. 5. 6.

MATERNAL:
PSYCHOLOGICAL UPSET PROLONGED LABOUR ABNORMAL UTERINE ACTION PAIN MORBIDITY OPERATIVE INTERFERENCE

1.

FETAL
IATROGENIC PREMATURITY HYPOXIA

2.

SELECTION OF TIME

MATERNAL: FETAL:

IRRESPECTIVE OF PERIOD OF GESTATION

AGE,MATURITY,DEGREE OF COMPROMISE
1.

SUCCESS OF INDUCTION DEPENDS ON

PERIOD OF GESTATION 2. CASE PROFILE SENSITIVITY OF UTERUS PREINDUCTION SCORING

3. 4.

BISHOP`S PREINDUCTION CX SCORING SYSTEM

FACTORS
O 1 2

SCORE
3

CX:
DILATATION CX LENGTH CONSISTENCY POSITION CLOSED >2 CMS 1-2 1 OR 2 3-4 <1 5+ FULLY TAKEN UP

Firm
POSTERIOR

med MIDLINE

Soft ANTEROR

HEAD
STATION TOTAL SCORE=13

-3

-2
FAVORABLE=6-13

-1,0

+1,+2
UNFAVOURABLE=0-5

METHODS OF RIPENING OF CX
1.PGE2 INTRACERVICAL OR INTRA VAGINAL 2.STRIPPING OF MEMBRANES

3.OXYTOCIN INFUSION

METHODS OF INDUCTION
*MEDICAL *SURGICAL *COMBINED MEDICAL INDUCTION

INDICATIONS: IUD,PROM,FAILED INDUCTION,WITH SURGICAL INDUCTION

DRUGS USED: OXYTOCIN,PGS

OXYTOCIN ; availability,<side effects DISADVANTAGES ; less effective in IUD, elderly primi PROSTAGLANDINS : intra cervical pgE2(1-3mg), PGE1(50mcg) Effectiveness: ^ in IUD, unfavourable cx,early gestation Advantages: no anti diuretic effect Drawbacks:^ side effects, hyperstimulation

COMMENTS: GOOD SCORE= BOTH EFFECTIVE, POOR SCORE= PG BETTER

SURGICAL INDUCTION
INDICATIONS:

DONE BY ARM

Adjunct to medical induction ContraindicationExclusive a)APH b) chronic hydromnios c)severe PIH IUD LIMITATION: unfavourable cx EFFECTIVENESS depends on 1)cx 2)station Mechanism: 1) stretching of cx 2)pg liberation 3)< in amniotic fluid volume METHODS: ARM----LRM,HRM Stripping of membranes

ARM
HAZARDS : 1. CORD PROLAPSE 2. AMNIONITIS 3. ACCIDENTAL INJURY 4. AMNIOTIC FLUID EMBOLISM IMMEDIATE BENEFICIAL EFFECTS Lowering of bp in PIH ECLAMPSIA Relieve maternal distress Control APH Relieve tension in abruptio

Combined method

1.

2.

Mainly used to decrease induction delivery interval Oxytocin + ARM PG+ ARM ADVANTAGES Most effective Shortens induction delivery interval

ACTIVE MANAGEMENT OF LABOUR

O`DRISCOLL AND COLLEAGUES IN 1984

Active= active involvement of obstetrician Applies exclusively to primigravida with singleton pregnancy Husband present during labour Analgesics Partogram ARM+ oxytocin Fetal monitoring KEY: STRICT VIGILANCE, ACTIVE AND INFORMED INTERVENTION

AIM
1. 2. 3. 4. 5.

To Expedite delivery <12 hrs with out increasing maternal morbidity and perinatal hazards Contraindications: other complication,FD, mutigravida ADVANTAGES <dysfunctional labour <duration of labour Early detection of fetal hypoxia Less operative delivery Less analgesia LIMITATION Applicable to selected case and centre more staff required