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Nor Fareshah bt Mohd Nasir

071303057
Batch 21/ F2

m m 

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˜ îîî ice org  revieî of


NICE iherited gidelie D
(CG70)
˜ îîî dcoslt co  boos 
Gabbe : Obstetrics Normal and
Problem Pregnancies, 5th ed.
˜ îîî îiipedia org
˜ Hacer ad Mooreǯs Essetials
of Obstetrics & Gyecology 5th
Ed
|  |  

˜ îîî ptodate co/cotets/i


dctiooflabor?
˜ Obstetrics Illstrated 6th Ed
˜ rotocols i O & G  Hospital
Melaa
6 
6 
|
˜ refers to the iatrogeic stilatio of terie
cotractios before the oset of
spontaneous labor to accoplish vaginal
delivery 1], 2]

˜ mnduction of labor is the process îhereby


labor is iitiated by artificial eas 3]

1] Gabbeǯs  dcoslt co


2]ptodate ic
3] Hacer & Mooreǯs
6 
  
|
˜ Êrtificial stilatio of labor that has beg
spotaeosly  ]

˜ refers to icreasig the frequency ad


iprovig the intensity of existig terie
cotractios i a patiet îho is i labor ad
ot progressig adeqately, i order to
accoplish vagial delivery 5]
 ] Hacer & Mooreǯs
2]Gabbeǯs obstetrics  dcoslt
‰     

˜ it is believed that the otcoe of the


pregacy îill be better if it is artificially
iterrpted rather tha beig left to folloî its
atral corse 6]
˜ Idctio of labor is oe of the ost
cooly perfored obstetric procedres i
the Uited States, UK 7], 
]

6] NICE iherited gigelie CG70


7,
]Gabbeǯs obstetrics  dcoslt ; NICE
    

˜ Cotiig the pregacy is believed to be


associated îith greater ateral or fetal ris
tha itervetio to deliver the pregacy

˜ here is o cotraidicatio to vagial birth

 ] UptoDate ic
6 | 6   !

aaternal fetoplacental
preeclapsia Êboral fetal testig
Diabetes Mellits Rh icopatibility
Heart Disease Fetalaborality
rologed regacy ROM
IUGR Chorioaioitis

10] Hacer & Mooreǯs


6 | 6   

Ê PT ÊT ÊTm  mNm ÊTmN


mNm ÊTmN

ypertensive disorders
reeclapsia / eclapsia Chroic hypertesio

aaternal medical conditions


Diabetes ellits SLE
Chroic ploary disease GDM
Real disease Hypercoaglable disease
Cholestasis
Prelabor upture of aembranes Polyhydramnios
horioamnionitis Fetal anomalies requiring special
neonatal care
11] Gabbeǯs obstetrics  dcoslt
6 | 6   

Ê PT ÊT ÊTm  mNm ÊTmN


mNm ÊTmN
Fetal compromise ogistic factors
Fetal groîth restrictio Ris of rapid labor
Isoiizatio Distace fro hospital
Noreassrig atepart fetal syshosocial idicatio
testig Êdvace cervical dilatatio
oligohydraios
Fetal demise Previous tillbirth
Prolonged pregnancy (>42 weeks) Postterm pregnancy (>41 weeks)

11] Gabbeǯs obstetrics  dcoslt


|6

a  
ÊBSOLU E † Cotracted pelvis 12] , active geital
herpes, placeta/vasa praevia , cord prolapse13]
RELÊ IVE †
´ rior terie srgery
´ Classic caesarea birth
´ Coplete trasectio of ters (yoectoy,
recostrtio)
´ Overdisteded ters
´ Ca cervix
12] Hacer & Mooreǯs
13] Gabbeǯs Obstetrics dcoslt
|6 "

Ú  
˜ preter fets îithot lg atrity
˜ Êcte fetal distress
˜ Êboral presetatio

1 ] Hacer & Mooreǯs


G| 6    
6   #

˜ Modified Bishop Score


˜ Fetal Fibroecti
˜ Soographically easred cervical legth

15] ptodate Ic


      
      

˜ Sigificace : to predict the sccess of labor


idctio16] or lielihood of vagial
delivery 17]
˜ high ( ι5 or ι
), the lielihood of vagial
delivery is siilar îhether labor is
spotaeos or idced
˜ low Bishop score is predictive that idctio
îill fail to reslt i vagial delivery 17]
16] Gabbeǯs Obstetricsdcoslt co
17] ptodate Ic
$ %  & '

˜ is a protei prodced by fetal cells ad is


fod at the iterface of the chorio ad the
decida (betîee the fetal sac ad the
terie liig) 1
]
˜ to predict terie readiess for idctio
˜ ositive shorter iterval to delivery, (eve i
lliparas îith loî (<5) Bishop scores) 1 ]

1
] îiipedia/fetal fibroecti
1 ] ptodate Ic
   

Pharmacological Non
Pharmacological
G | 

˜ PG2 ˜ aisoprostol IUFD


† vagial * ˜ aifepristone
† Oral ˜ thers :-
† IV † Hyalroidase
† Extraaiotic † Corticosteroids
† Itracervical † Estroge

˜  ytocin
† IV*
† With aiotoy
 G | 

Gm Ê

NN-Gm Ê
 G | 

Gm Ê NN Gm Ê


˜ ebrae sîeepig
˜ Êiotoy ˜ O HERS
˜ Mechaical ethod † Herbal sppleets
† Balloo catheters † Êcpctre
† Laiaria tets † Sexal itercorse
† Breast stilatio
† Hot baths, castor oil
G ($

˜ MOÊ : dissoltio of collage bdles & a


icrease i sbcosal îater cotet of the
cervix † siilar to those observed i early
labor; ad ediates terie cotractio
˜ Gs are endogenous copods fod i
the yoetri, decidas, ad fetal
ebraes drig pregacy 20]

20] Gabbeǯs Obstetrics dcoslt


' )($ G *
G 
&   '* 
˜ ablets  3g for favorable cervix
˜ Gel  2 5 5 g
˜ Cotrolled released pessary  10g favorable

˜ Êdvatages
† Less ivasive
† Coveiet
† Less H
20] NICE gidelies
|  |(

˜ Favorable cervix  1 cycle of tab/gel 21]


† 3g tab (prii), 1 5g tab (lti)
† Êfter 6 hors if still ot deliver
† GIVE 1 5g tab

˜ Ufavorable cervix  1cycle of cotrolled


released pessary 22]
† 1 dose i 2 hors

21]Melaa Hospital rotocols


22]NICE gidelies
G *+  

˜ Êll regies have ris of :

23]NICE gidelies
 m
$$ 
       6 
MODE 2 ]
˜ Êloe
˜ With aiotoy
˜ Folloîig cervical ripeig

less efficacy copared to vagial GE 2 ]


˜ Feîer vagial birth i 2 hrs
˜ Loîer bishop score
˜ More Csectio birth
2 ]NICE gidelies
G$ p p
 *#
˜ Itraveosly
˜ dilte ifsio, ad "piggybaced" ito the
ai itraveos lie
˜ calibrated ifsio pp
˜ ot exceed 72 hors
˜ If adeqate labor achieved, redce ifsio
rate ad the cocetratio

25]Hacer & Mooreǯs


   , 
  *-
˜ TmN
10 its of oxytoci i 1000 L of 5%
dextrose or balaced salt soltio (10
U/L)

˜ ÊamNmTÊTmN
iggybac ito ai IV lie; adiister
soltio by ifsio pp
26]Hacer & Mooreǯs
.   $ 
, */

˜
PTmaÊTmN † fetal distress
˜   WÊT mNT m ÊTmN † ÊDH lie
effect
˜ TmN a  FÊTmG (postdelivery
atoy)

27]Hacer & Mooreǯs



     6

1 Balloo Catheters
2 Laiaria tets
    |
|  
 $  +*0

Ê ÊNTÊG mÊ ÊNTÊG


˜ Less ris of terie ˜ Neoatal ifectio
hyperstilatio
˜ Redce ris of rptre is
presece of Csectio scar

Overall † îhe copared to rostagladis by


ay rote, DOES NO IMROVE rate of vagial
births îithi 2 hrs & rate of csectio

2
] NICE gidelies
*
% 1( & '

˜ assig exaiig figer throgh cervix


š
Rotates agaist îall of ters beyod iteral
os
š
Strip chorio aîay fro decida (richest sorce
of prostagladis)
% 1(  2

˜ rior to idctio, îoe shold be offered


vagial exa for ebrae sîeepig, esp
0, 1 îees OG

˜ If labor does ot start spotaeosly,


additioal ebrae sîeepig
% 1(  

˜ redced eed for foral idctio of labor,


especially i ltiparos îoe
˜ icreased rate of spotaeos labor, if
perfored ore tha oce fro 3
îees of
gestatio; the ost appropriate regie is ot
clear fro the evidece
˜ icreased icidece of coplicated bleedig
˜ icreased reports of pai bt ost îoe
îold still choose sîeepig i a ftre
pregacy ad recoed it to frieds

2 ] NICE gidelies
| 6  6 |3!
 Uterie cotractios
 Fetal oitorig
 C G  îatch ot for hyperstilatio
 Glcoeter 2 horly (GDM/DM)
 B horly (IH/H N)
 Êdeqate sedatio if i pai?
 heerga 25 g stat, pethidie 75 g stat

30] Hospital Melaa protocols


| 6  6 | 3 

 F: Bishop score assess** & record, FHR


cofired îith EFM (electroic fetal oitorig)

 mNG : cotios electroic fetal heart


oitorig, terie cotractio

** 6hrs after vagial GE2


2 hrs after GE2 cotrolled release pessary

31] NICE gidelies


p p
p 
m p

32] NICE gidelies


1. TmN
PTmaÊTmN

2. FÊm mN TmN

3.  PÊP

4. TmN PT
    $
$4

˜ Êt  am except Satrday, Sday & blic


holiday less exceptioal cases 33]
˜ îoe ore satisfied îhe idctio taes
place i the orig 3 ]

33] rotocols of Hospital Melaa


3 ] NICE gidelies
G  6 |

1) rologed pregacy
2) ROM
3) ROM
) revios Csectio
G  6 |

5) Breech
6) IUGR
7) H/O recipitated Labor

) IUFD