induction of labour (4)(1).pptx

inducation of labour

1. Out line INTRODUCTION DEFINITION INDICATION BISHOPE SCORE CONTRAINDICATIONS METHODS OF INDICATIONS COMPLICATIONS

2. INTRODUCTION inducing labor is the stimulation of uterine contractions during pregnancy before labor begins on its own to achieve a vaginal birth. A health care provider might recommend labor induction for various reasons, primarily when there's concern for a mother's health or a baby's health. Inducing labor can be accomplished with pharmaceutical or non-pharmaceutical methods . It is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes induction of labour is most easily judged by assessing the progress of cervical ripening.

3. INTRODUCTION This offers the best prognostic index of successful induction of labour. if the Bishop score is high, reflecting a high degree of cervical ripeness induction of labour usually can be achieved with very simple types of intervention. If, on the other hand, the Bishop score is very low (regardless of the gestational age of the pregnancy), it is much more difficult to bring about the conditions in which labour will begin and consequently those efforts are much more likely to fail.

4. Definition A process whereby labour is initiated by artificial means after appropriate assessment of the mother and fetus , (technique for stimulating uterine contractions to accomplish delivery prior to the onset of spontaneous labour )

5. INDICATION Postterm pregnancy WHO has recommended to indu ce labour after (40 weeks + 7 days ) After 42 weeks , placenta can no longer provide enough oxygen and nutrients for the baby 2. Prelabor rupture of membranes is leakage of amniotic fluid before onset of labor Prelabor rupture of membranes (PROM) may occur at term (≥ 37 weeks) or earlier (called preterm PROM if < 37 weeks).

6. INDICATION 3-COMPLICATIONS Infection (biggest risk) If the uterus becomes infected (chorioamnionitis), the baby must be delivered immediately . For preterm PROM , : the biggest risk is a preterm delivery, which increases risks of complications for the baby. These complications include: learning disabilities neurological problems respiratory distress syndrome Another serious complication is umbilical cord compression. ) Without amniotic fluid, the umbilical cord is vulnerable to damage ( Placental abruption ( early detachment of placenta from uterus ( , Postpartum infection

7. INDICATION Preterm PROM before the 24th week , it often results in death of the fetus because the baby’s lungs are not able to develop properly. If the baby survives, they will often have long-term problems, including: chronic lung disease developmental problems hydrocephalus cerebral palsy . Nearterm,term or postterm : The gynecologist will proceed to deliver the baby. Labor might occur by itself (spontaneously) o r by inducing labor using certain medications.

8. INDICATION 4-Chorioamnionitis : is a bacterial infection that occurs before or during labor. infection that can occur when bacteria that are normally present in the  vagina   ascend into the  uterus , where the fetus is located. E. coli ,  group B streptococci , and anaerobic bacteria are the most common causes of chorioamnionitis. The amniotic fluid and placenta and baby can become infected.

9. INDICATION 5-O ligohydramnios it is the condition that the uterus has not enough amniotic fluid Causes : 1- PROM 2- problems with the placenta 3- birth defects 4- postterm pregnancy 5- medications 6- health conditions in mom

10. INDICATION 6-Placental abruption .  Your placenta peels away from the inner wall of the uterus before delivery — either partially or completely . 7- Fetal growth restriction   The estimated weight of your baby is less than the 10th percentile for gestational age 1- G estational diabetes 2- Hypertensive disorders 3- Certain medical conditions HELLP syndrome : The HELLP syndrome is a serious complication of pregnancy characterized by haemolysis,elevated liver enzymes and low platelet count

11. Bishop score definition : also Bishop's score or cervix score, is a pre-labor scoring system to assist in predicting whether induction of labor will be required. _The Bishop score grades patients who would be most likely to achieve a successful induction. _ Used to determine the degree of cervical ripening Cervical ripening _ is a normal process of softening and opening the cervix before labor starts. _ often happens on its own, naturally

12. Bishop score Components The total score is calculated by assessing the following five components on manual vaginal examination by a trained professional : Cervical dilation in centimeters Cervical effacement Cervical consistency by provider assessment/ judgement Cervical position Fetal station, the position of the fetal head in relation to the pelvic bones

13. Bishop score Interpretation : A score less than 5 suggests that labour is unlikely to start without ripening of the cervix, A score of 7 indicates that labour has begun or is imminent.

14. Contraindication induction of labor is stimulation of uterine contractions before spontaneous labor to achieve vaginal delivery. Induction of labor can be : Medically indicated ( eg , for preeclampsia or fetal compromise) ,Elective (to control when delivery occurs) ,Before elective induction, gestational age must be determined. Commonly, elective induction has been avoided at 39 weeks because of lack of evidence for perinatal benefit and concern about a higher frequency of cesarean deliveries and other adverse outcomes. This practice may be changing, partly because a 2018 study showed that induction of low-risk women at 39 weeks reduced the frequency of cesarean deliveries (but not perinatal adverse outcomes) compared with expectant management

15. Contraindication Contraindications to induction include : Fundal uterine surgery Open maternal-fetal surgery ( eg , myelomeningocele closure) Myomectomy involving entry into the uterine cavity Prior classical (vertical) cesarean incision in the thickened, muscular portion of the uterus Active genital herpes Placenta previa or vasa previa Abnormal fetal presentation ( eg , transverse lie, umbilical cord presentation, certain types of fetopelvic disproportion) Multiple prior uterine scars and breech presentation are relative contraindications

16. METHODS OF Induction Natural Ways to Induce Labor Exercise : 1- Sex 2- Nipple stimulation 3-Acupuncture 4-Acupressure 5- Castor oil 6-Spicy foods . Exercise can be anything that gets the heart rate up, such as a long walk. Even if this method doesn’t work, it’s a great way to relieve stress and keep your body strong for the task a head. Sex : Theoretically , there are multiple reasons why having sex could induce labor For example Sexual activity, especially having an orgasm, can release oxytocin, which may help jumpstart uterine contractions.

17. METHODS OF I nduction Nipple stimulation: Stimulating your nipples can cause your uterus to contract and may bring about labor. Nipple stimulations stimulate oxytocin production. Oxytocin is the hormone that causes the uterus to contract and the breast to eject milk . In fact, if you choose to breastfeed your baby right after delivery, this same stimulation is what will help your uterus shrink back to its original size . Acupuncture: Acupuncture has been used for thousands of years. The exact way that acupuncture works is unclear. In Chinese Medicine, it’s believed that it balances the chi or vital energy within the body. It might also stimulate changes in hormones or in the nervous system. Acupuncture should be administered only by a licensed acupuncturist.

18. METHODS OF Induction Acupressure : Some practitioners believe that acupressure can help start labor. If acupressure doesn’t get your labor going, it can still be an excellent way to alleviate pain and discomfort during labor. Castor oil: Drinking a little bit, like only 1–2 ounces (29.57–59.14 mL) of castor oil stimulates prostaglandin release, which can help ripen the cervix and get labor started. It’s recommended that this be done under the supervision of a midwife or doctor. People should be careful not to drink too much.

19. METHODS OF Induction Eating dates: Some Trusted Source research shows that eating dates in the final weeks of pregnancy increases cervical ripening and cervical dilation at the start of labor decreases the need for Pitocin use during labor . Medically Induced Labor :   Many doctors will recommend induction if your pregnancy goes beyond 41 or 42 weeks since your placenta becomes less efficient at nourishing your baby by that time.2 Some doctors suggest inducing at 39 weeks since research shows that babies born then have the healthiest outcomes.3 Before that, induction is only recommended when your health or your baby's health is at risk due to infection, a medical condition like preeclampsia, low amniotic fluid levels, or other problems.

20. METHODS OF Induction Membrane Sweep: Membrane sweeping or stripping is when a doctor, midwife, or doula gently separates the amniotic membrane from your cervix to stimulate the release of prostaglandins, hormones that are essential for "ripening" (softening) the cervix in preparation for delivery.“ ays . Amniotomy : Most people go into labor within hours after their water breaks (when the fluid-filled amniotic sac bursts).By artificially rupturing this sac

21. METHODS OF I nduction . Balloon Catheter : A balloon catheter, otherwise known as a Foley Bulb, is another option to discuss with your medical team if your birth is being induced. In this procedure,a catheter is placed and inflated with sterile water above the cervix, insidethe uterus. The balloon mechanically dilates the cervix . Balloon catheter induction does not require the use of medications, it can be used in conjunction with medications such as Cytotec (misoprostol). Pitocin / Oxytocin IV Infusion : Administered at a hospital under close medical supervision, pitocin and oxytocin infusions can be used to increase the rate and strength of contractions.

22. COMPLICATIONS Inducing labor carries various risks, including : Failed induction : About 75 percent of first-time mothers who are induced will have a successful vaginal delivery. This means that about 25 percent of these women, who often start with an unripened cervix, might need a C-section. Your health care provider will discuss with you the possibility of a need for a C-section . Low heart rate: The medications used to induce labor — oxytocin or a prostaglandin — might cause abnormal or excessive contractions, which can diminish your baby's oxygen supply and lower your baby's heart rate Infection : Some methods of labor induction, such as rupturing your membranes, might increase the risk of infection for both mother and baby.

23. COMPLICATIONS Uterine rupture : This is a rare but serious complication in which your uterus tears open along the scar line from a prior C-section or major uterine surgery. An emergency C-section is needed to life-threatening complications. Your uterus might need to be removed . Bleeding after delivery: Labor induction increases the risk that your uterine muscles won't properly contract after you give birth (uterine atony ), which can lead to serious bleeding after delivery

24. NURSING CARE PLAN The nursing care plan for a client in labor includes providing information regarding labor and birth, providing comfort and pain relief measures, monitoring the client’s vital signs and fetal heart rate, postpartum care, and preventing complications after birth . Here are nursing care plans (NCP) and different stages of labor: First stage of labor This stage of labor is divided into three phases. The  latent phase  starts during the onset of true labor contractions until cervical dilatation. The  active phase  occurs when cervical dilatation is at 4 to 7 cm and contractions last from 40 to 60 seconds with 3 to 5 minutes interval. The  transition phase   occurs when contractions reach their peak with intervals of 2 to 3 minutes and dilatation of 8 to 10 cm.

25. NURSING CARE PLAN Second stage of labor This stage starts at full cervical dilatation until the birth of the infant. The woman may experience an uncontrollable urge to push and bear down with every contraction. Crowning  or the appearance of the fetal head on the vaginal opening occurs . Third stage of labor The third stage begins with the birth of the infant until the delivery of the  placenta . The signs of placental expulsion are lengthening of the umbilical cord, sudden gush of vaginal blood, changes in the shape of the uterus and its firm contraction, and the appearance of the placenta at the vaginal opening.

26. NURSING CARE PLAN Planning :- With all the data gathered during assessment and through an accurate diagnosis, a care plan for the woman in labor would be made to aid her through her progress . Care of a woman in the first stage of labor Labor should be allowed to start naturally, not artificially induced. The woman must also be allowed to move freely throughout the labor. Artificial interventions should also be prohibited. Allow the woman to assume a non- supine  position for delivery. Upon delivery of the  newborn , mother and child should be given unlimited opportunity for  breastfeeding  and bonding

27. NURSING CARE PLAN Care of a woman in the second stage of labor During the second stage of labor, the place of delivery of the woman must be prepared. The position of birth wherein the woman is most comfortable must also be determined at this stage. Another important part is the promotion of second stage effective pushing. Perineal cleaning is also an integral part of the second stage. Care of the woman in the third stage of labor Placental delivery should be given focus at this stage. Once the placenta is delivered,  oxytocin  should be administered intramuscularly to promote uterine contractions. If there is  episiotomy  performed, perineal repair should be integrated into the care plan.

28. NURSING CARE PLAN different stages of labor : Third Stage of Labor : Transition phase