LABOUR
NUR HANANI BINTI MOHD KHAN
0313883
DEFINITION
Induction of labour = artificial stimulation of uterine contractions prior
to the spontaneous onset of labor.
Augmentation of labour = process of stimulating the uterus to increase
the frequency, duration and intensity of contractions after the onset
of spontaneous labour
The aim of IOL is to eliminate the potential risks to the fetus with prolonged
intrauterine existence while minimizing the likelihood of operative delivery
MATERNAL INDICATIONS
INDICATIONS
WHEN TO
INDUCE
REASONS
38 weeks/
earlier
Pre-eclampsia /
maternal
hypertensive
disorder
37-38 weeks
Placenta abruption
37 weeks with
close
monitoring
Prelabour rupture
membrane (PROM)
Immediate
(within 48
hours) (if
FETAL INDICATIONS
INDICATIONS
WHEN TO INDUCE
REASONS
Prolonged pregnancy
41-42 weeks
RH incompatibility
as soon as lung
matured
Intrauterine growth
restriction (IUGR)
- Depends on
biophysical profile
Intrauterine death
(IUD)
- immediate
CONTRAINDICATIONS
ABSOLUTE
- Scarred uterus
- Previous C-section uterine rupture
- Preterm gestation at <34 weeks
higher risk of failure & C-section is
more preferable
- Multiple pregnancy
- Polyhydramnios
- Grand multiparity
- Maternal heart disease
- cannot use hormonal method
of IOL
- Abnormal fetal heart rate that is not
requiring emergency cesarean
section
BREAST STIMULATION
Stimulation of nipples release of oxytocin from
posterior pituitary helps uterine contraction to start
-
MEMBRANE SWEEP
- Circular sweeping of the cervical os Digital separation of chorionic
membrane from the underlying decidua increase local production of
prostaglandins initiate labour
- prior to rupture of membrane
- simple, safe and beneficial for IOL
- Sweeping membranes from 38 weeks of pregnancy onwards reduces the
rate of prolonged pregnancy
- uncomfortable & possible if cervix is beginning to dilate & efface
- only done at term
OXYTOCIN
IV infusion after rupture of membranes
starting infusion rate is low and defined increments follow every 30 mins until
3-4 uterine contractions are achieved every 10 mins, each lasting 40-60s
MOA
initiate myometrial contractions
stimulates amniotic & decidual prostaglandin production
Side Effects
SYNTOCINON
- Synthetic derivative similar in action to oxytocin
- has longer half life (5-12 minutes) than natural oxytocin
- often as an adjunct to rupture of membrane with favourable cervix
- given intravenously as a constant low dose at less than
10milliunits/min
- brand name : pintocin
*continuous CTG monitoring to avoid risk of uterine hyperstimulation
PROSTAGLANDINS
- Used for cervical ripening and induction of labour
- commonly used are Prostaglandin E2 (dinoprostone) and
Prostaglandin E1 (misoprostol)
- Contraindications : hypersensitvity, uterine scar, active cardiac,
pulmonary, renal, hepatic disease, bronchial asthma
- Side effects:
pyrexia, vomiting, diarrhea, headache,
chills and
Dinoprostone
Misoprostol
exacerbation of severe asthma
- inserted vaginally into posterior
- Transvaginal (25mcg fourfornix as tablet/gel, 2 doses with
hourly) / oral (should not
at least 6 hrs apart
more than 50mcg)
- a controlled-release pessary left
- SE: tachysystole,
in place up to 24 hrs
meconium passage, uterine
- Higher rate of uterine
rupture
hypertonus / hyperstimulation
MIFEPRISTONE
- is a progesterone receptor blocker
- inhibitory effects of progesterone on the uterus sensitize myometrium
to prostaglandin-induced contraction contraction of the uterus
and ripens the cervix
- widely used in 2nd semester termination of pregnancy
- combination of mifepristone and misoprostol currently used in the UK only
to induce labour following IUD
LAMINARIA TENT
HYGROSCOPIC
DILATORS
ARTIFICIAL RUPTURE OF
MEMBRANE (ARM)
- Artificial rupture of membrane initiate inflammatory response release of endogenous prostaglandins cervical
ripening & uterine contraction
- also use to observe amniotic fluid for blood or meconium
- Cannot be employed in an unfavourable cervix (long, firm cervix with closed os). Cervix should be at least 1cm
dilated.
- Usually started with oxytocin to reduce fetal & maternal risk of sepsis
- Advantages
1.
b/p in pre-eclampsia
2.
Relief maternal distress in hydramnios
3.
Control bleeding in APH
4.
Relief of tension in placenta abruption & initiation of labour
- Disadvantages
5.
Umbilical cord prolapse
6.
Amnionitis
7.
Accidental injury
8.
Liquid amnii embolism
.-
COMPLICATIONS
pain and use of epidural and analgesia
Long labours
haemorrhage
augmented
with
oxytocin
uterine
atony
Postpartum
REFERENCES
Dutta, DC (2013)DC Dutta's Textbook of Obstetrics, 7th ed., New Delhi: Jaypee Brothers
Medical Publishers (P) Ltd.
Collins, Sally., Arulkumaran, Sabaratnam., Hayes, Kevin., Jackson, Simon., Impey,
Lawrence. (2015)Oxford Handbook of Obstetrics and Gynaecology, 3rd ed., page 57,
Great Clarendon Street: Oxford University Press.
N Baker, Philip., C Kenny, Louise (2011)Obstetrics by Ten Teachers, 19th ed., Great
Clarendon Street: CRC Press.
NICE guidelines (2016)Inducing labour,Available
at:https://www.nice.org.uk/guidance/cg70/chapter/1-Guidance(Accessed: 22nd April
2016).
Kavanagh J, Kelly AJ, Thomas J. Breast stimulation for cervical ripening and induction of
labour. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003392. DOI:
10.1002/14651858.CD003392.pub2.
THANK YOU