KUHS Essay Discussion

Dr GAYATHRI MS , MBBS, MD AIIMS DELHI, DNB, MRCOG , FMAS

 Induction of labour

• Pre-induction criteria or assessment

• Indication?

• Complication
 Indications
• MATERNAL
• FETAL

❖ Hypertensive disorders of pregnancy ❖ Fetal growth restriction

❖ Gestational diabetes mellitus ❖ Post dated pregnancy
❖ Intrahepatic cholestasis of pregnancy ❖ Rh isoimmunisation
❖ Premature rupture of membrane ❖ Decreased fetal movenents
❖ Maternal medical conditions(DM, Chronic ❖ Non reassuring fetal status
hypertension ,APLA ,renal disease, chronic ❖ Macrosomia
pulmonary disease ) ❖ Fetal anomalies incompatible with life
❖ Abruptio placentae ❖ Fetal demise
❖ Chorioamnionitis
❖ Previous obstetric history( H/O Intrauterine demise
, precipitate labour)

 PREINDUCTION ASSESSMENT
❖ Consent and counseling

❖ Confirm the gestational age, indication of induction

❖ Rule out Contraindications

❖ Confirm the lie & presentation

❖ Labour admission test/ NST

❖ Pelvic assessment

❖ Cervical status ( bishops score )

❖ Check the drug list she is on

❖ Current investigations of the disease status

 Complications of Induction
• Uterine contraction abnormalities

• Fetal heart rate decelerations

• Increased operative deliveries

• Uterine rupture

• Cord prolapse

• Failed Induction

• Risk of infection

• PPH

 Contra indication
• MATERNAL. FETAL
❖ Placenta previa or vasa previa ❖ Abnormal lie
❖ Inadequate pelvis ❖ Severe hydrocephalus
❖ Previous uterine rupture ❖ Multiple pregnancy with first non
cephalic
❖ cord prolapse
❖ Previous classical c/s
❖ Active genital herpes infection
❖ Previous myomectomy entering the
endometrial cavity
❖ Invasive cervical carcinoma
❖ Previous surgeries( 2 or more CS,
perineal surgeries, fistula repair,
prolapse surgeries)
❖ Space occupying lesion in lower
pelvis ( lower segment fibroid )
❖ Maternal med disease(heart ds)