Induction and augmentation

July/2019
AMU
 Objectives
• At the end of this class student should be able to
– Define labor induction and augmentation
– Describe the Incidence and Indications for induction
and augmentation
– List the Contraindications
– Mention Complications
– List the Prerequisites
– Describe the Methods of induction and
augmentation
 Definition
• Induction of labor: refers to the iatrogenic
stimulation of uterine contractions before the
spontaneous onset of labor, with the goal of
achieving delivery.
– Induction of labor should be undertaken when the
benefits of immediate delivery to either mother or
fetus outweigh the risk of continuing the
pregnancy.
 Types of induction
1. Planned/elective

2. Emergency
 Augmentation of labor
• Is the stimulation of uterine contractions that
began spontaneously but are either too
infrequent or too weak, or both.
 Indications
A.Maternal: HDP, chorioamnionitis, Rh-
isoimmunization, diabetes at term, CRD, COPD

B.Fetal:congenital anomalies not compatible

with life (eg. Anencephaly), placental
abruption, term prolonged PROM, IUGR, non-
reassuring antepartum fetal testing,
oligohydramnios, IUFD, prolonged pregnancy
 Contraindications
A. Absolute: Prior classic uterine incision or
transfundal uterine surgery or metroplasty,
active genital herpes infection, placenta previa
(major) or vasa previa, umbilical cord prolapse,
transverse or oblique fetal lie, gross CPD, footling
breech, pelvic tumor obstructing the birth canal
(tumor previa), acute fetal distress, two or more
LUST cesarean scar, invasive cervical cancer.
B. Relative:1xLUSTC/S, frank breech, face with MA
Types of uterine incisions
 Complications of induction
A.Maternal
Hyperstimulation (Hypersystole and tachysystole),
failed induction, sepsis, hyponatremia, PPH, ux
rupture
B.Fetal
iatrogenic prematurity, fetal asphyxia, rupture of a
vasa previa, umbilical cord prolapsed, placental
abruption,,
 Prerequisites
A. Maternal
– Confirm indication for induction and review
contraindications to labor and/or vaginal delivery
– Perform clinical pelvimetry to assess pelvic shape
and adequacy of bony pelvis
– Assess cervical condition (assign Bishop score)
– Review risks, benefits and alternatives of induction
of labor with patient
 Prerequisites …
 B. Fetal
– Confirm gestational age
– Assess need to document fetal lung maturity
status
– Estimate fetal weight (either by clinical or
ultrasound examination)
– Determine fetal presentation and lie
– Confirm fetal well-being
 Prerequisites …
C. Institutional
– Ascertain availability of labor ward staff
– capability to perform cesarean Section
– Blood/NICU/ Anesthesiologist
 Bishop’s pelvic scoring system
Modified Bishop Score
Parameter Score

0 +1 +2 +3

Cx dilatation C 1-2 3-4 >5

Cx effacement 0-30 40-50 60-70 >80

**
Cx position P M A

Cx consistancy H IM Soft -

Cx length** >4 2-4 1-2 1-2

Station -3 -2 -1/0 +1/+2

 MODES OF INDUCTION
A.Pharmacological
1. Prostaglandins
PGE2 (Dinoprostone)
-0.5 mg dinoprostone (prepidil).
-10 mg dinoprostone vaginal insert (Cervidil)
PGE1 (Misoprostol)
2.Oxytocin induction:
Dinoprostone gel
Dinoprostone insert
Pitocin/ oxitocine
 Methods of induction…
B. Mechanical
1.Transcervical balloon catheter
 
2.Hygroscopic dilators
Laminaria tents
Transcervical balloon catheter
 Methods of induction…
C. Surgical
1. ARM
2. Sweeping or stripping of the membranes
3. Drainage of the hinde water
Sweeping or stripping of the membranes
 Failed induction
Failed induction is diagnosed when there has
been no cervical change or descent of the
presenting part after 6-8 hours of labor, or
contraction of 3 in 10 min. has not been
achieved.
 AUGMENTATION OF LABOR

• Definition
• Indications
• Contraindications
• Complications
• Prerequisites
• Methods
– Dosage – half dose of induction