Induction of Labour

Induction of Labour

Definition: 

Induction is the initiation of uterine contractions by artificial means after 28 weeks of gestation before the onset of labour with purpose of effecting a birth of the baby.

Indication

Induction of labour should be done if the health and wellbeing of the mother or the fetus would be affected if the pregnancy should continue.

Indications

Prolonged pregnancy, Diabetes mellitus – Big baby , Pre-eclampsia and Essential Hypertension , Diminished fetal well being , Placental insufficiency , Rubella in current pregnancy, Early rupture of membranes – Draining of liquor aft er 12hrs, Cardiac conditions , APH types 1 & II anterior – Ab ruptio Placneta , Acute hepatitis , Previsous precipitate labour, Chronic Nephritis , Fetal conditions – Big baby, in trauterine growth retardation, Anencephaly, Fetal Death in utero – previous still birth , unstable lies , Polyhydramnios , Bad Obstetric history – elderly Primigravida, Social re asons, Rhesus incompalibility .

Types

1.           Surgical Induction

2.           Medical Induction

It is always good to combine the two.

Methods

 Surgical Induction includes

1. Stimulation of the cervix – stripping of the membranes. It isenough to commence labour – PG E ₂ is rapidly produced as fetal membranes are the detached from the deciduas.

a. It can lead to removal of operculum

b. It can lead to infection if labour does not start 2-3 days.

2. Artificial Rupture of membranes – (ARM) Amniotomy.

i. Forewater Rupture of membranes – using Amniotomy forceps or Amnihoook, kocher’s forceps Danger – Cor d prolapse, Infection.

ii. Hindwater Rupture of membranes – using Drew symthe catheter.

iii. Danger – Placenta separation, can puncture chorion , Infection, cord prolaps may occur.

Medical Induction

1. Oil, Bath, Enema – OBE Oil – castol oil

Bath – Hot Bath

Enema – Hot, High and a lot.

This enough can stimulate uterine contraction if pregnancy is term and ready.

2. The use of Oxytocin:

Intravenous infusion of syntocinon or pitocin can be used.

Technique of Administration: the lie, presentation, fetal heart rate are checked, CPD excluded.

·              Enema is given.

·              Assess the condition of the cervix – dilatation and consistency using the Bishops score 5-10

·              Membranes are ruptured.

Preparation

Preparation of the Patient

1.           Explain the procedure to the woman .

2.           Patient’s health must be ascertained.

3.           Shave the vulva and wash, ensure the woman empties her bladder

4.           ARM is done in the morning of the procedure

5.           Inform specialists – paediatrician, haematologist

Role of midwife

1.           Label the bottle – unit, time of starting

2.           Monitor the drops

3.           Monitor the strength, consistency and frequency of contractions and vital signs quarter hourly.

4.           Monitor the progress of labour and fetal condition

5.           Intake and output chart is kept

6.           Give Psychological support

7.           Make patient aware of progress of labour. 

8.           Notify Dr. Early and stop drip in case of any complications.

9.           Relief pains as necessary.

Indication for stopping the drip

1.           Over stimulation of the uterus

2.           Strong contractions

3.           Tonic uterine contractions

4.           Deterioration in the woman’s condition – e.g. incr eased B/P, maternal or fetal distress, pre-eclampsia if due to over stimulation or tonic contraction give 2 puffs of ventolin inhaler before Doctor’s arrival.

Bucal Pitocin

It is given inform of tablet. It brings out erratic absorption and contraction is uncontrollable. It can cause uterine spasm and fetal anorexia. Dosage 10 unit in each bucal and another ½ hourly 2, 50, 50, 100, 100 units. If there is fetal distress or hypertonic uterine action the tablets are removed.

Prostaglandin

This is a hormone in the prostate gland but present in females. It causes contraction of the uterine muscles. It is useful in ripening of the cervix prior to induction by oxytocin or Amniotomy.

It may be used in form of passaries,  tablets , or  gel .

Favourable Factors

·              Ensure fetal maturity

·              Consider the gestational age, it is better when pregnancy is at term above 38 weeks.

·              Ripening of the cervix – Bishops score: A score of 6 and above is favourable with level of presenting part at 3/5 or less above the brim. (good prognosis). Must ascertain the lie, is longitudinal presentation ,cephalic, Fetal Heart Rate are checked. Exclude CPD – obtain consent from the husb and or the woman.

·              5 Features are considered, each is awarded 0-3. A score of 6 above is favourable and of good prognosis – Referred to a s “Ripe cervix”.

Bishop’s Score

Favourable score 6-10

Unfavourable 0 – 5 score