induction of Labour.pptx

The rate of induction of labor has continued to trend upward. Regardless of whether labor is induced or spontaneously occurs, the goal is vaginal birth.

1. Induction of Labour Dr Samson Ojedokun LAUTECH Teaching Hospital Ogbomoso Nigeria 1

2. OUTLINE Introduction Indications & Contraindications Prerequisites Cervical Ripening Methods of Induction of labour Complications Conclusion 2

3. INTRODUCTION Induction of labour is the artificial initiation of uterine contraction after the age of viability in a pregnant woman with intact membranes with the aim to achieve vaginal delivery. The rate of induction of labor has continued to trend upward.   Regardless of whether labor is induced or spontaneously occurs, the goal is vaginal birth. 3

4. INDICATIONS Fetal/Maternal Postdate pregnancy Preeclampsia/eclampsia Antepartum haemorrhage at term Rhesus isoimmunization IUGR Fetal anomaly 4

5. Previous intrauterine fetal death at term Chorioamnionitis Premature rupture of membrane Previous precipitate labour Severe abruptio placentae with dead fetus Elderly primigravida at term 5

6. Medical Heart disease Diabetes mellitus Renal disease Chronic liver disease 6

7. CONTRAINDICATIONS Absolute Contracted pelvis Previous ruptured uterus Previous classical hysterotomy Two or more previous c/s Major placenta previa Persistent transverse/oblique lie Abnormal presentation like brow or face mento-posterior Pelvic tumour e.g. ovarian cyst, horseshoe kidney, pedunculated fibroid 7

8. Relative Prematurity Breech presentation Multiple gestations Grand multiparity Suspected fetal macrosomia Oligohydramnios 8

9. PREREQUISITES Valid indication Informed consent Fetal maturity assessment Pelvic assessment Exclude all contraindications to vaginal delivery Adequate staff for induction of labour Adequate knowledge of induction procedure Pre-induction cervical status must be favourable based on Bishop score 9

10. CERVICAL RIPENING Cervical ripening is an important first component of labour induction.  It involves softening and remodeling of the connective tissue components of the cervix. Ripening often stimulates labour. The Bishop scoring system is used to determine favorable or unfavorable cervix. If the cervix is deemed unfavorable, usually defined as Bishop score less than or equal to 6, cervical ripening is indicated. 10

11. Bishop score 0-5 low score 6-13 high score 11

12. Methods of Cervical Ripening Mechanical Methods Transcervical Foley’s catheter Extraamniotic Saline Infusion Double Balloon Catheter Osmotic dillators : Seaweed e.g laminnaria Synthetic compounds eg lamicel , dilapan 12

13. Intracervical foley’s catheter 13

14. Double balloon catheter 14

15. Laminaria 15

16. Pharmacologic methods Prostaglandins PGE1, misoprostol Intravaginal 25mcg 3-6hly or Orally, 100mcg PGE2, Dinoprostol Intracervical gel in a 2.5mL syringe containing 0.5 mg or vaginal pastry containing 10mg. 16

17. Non-pharmacologic methods Nipple stimulation Membrane sweeping Amniotomy Sexual intercourse 17

18. Methods of Induction of Labour Medical Oxytocin titration Misoprostol Surgical Amniotomy (ARM) 18

19. Complications of Induced Labour Maternal complications Failed induction Increased risk of C/S Uterine inertia Prolonged labour Tumultuous labour and tetanic contraction Premature placental separation Intrapartum bleeding 19

20. Amniotic fluid embolism Precipitate labour Postpartum haemorrhage Cervical laceration Sepsis Hyperstimulation Genital injuries Fetomaternal death 20

21. Fetal complications Cord prolapse Fetal distress Iatrogenic prematurity 21

22. CONCLUSIONS Induction of labor is a viable therapeutic option for appropriately selected patients; however, the benefits of continuing a pregnancy must be outweighed by the potential maternal and fetal risks associated with the procedure 22

23. Thank you 23