INDUCTION AND AUGMENTATION OG LABOUR

INDUCTION AND AUGMENTATION OF LABOUR DR. S.N. BERA DR. MITALI DASHM.K.C.G MEDICAL COLLEGE, BERHAMPUR

Induction of labour Initiation of uterine contraction artificially after the period of viability before onset of labour for the purpose of secure vaginal delivery. Augmentation of labour The process of stimulation of uterine contraction (both in frequency and intensity) that are already present but found to be inadequate.

Normal labour

Induction of labourIncidence 10%The over all incidence increased globally.According to National Center for Health Statistics 90/1000 live birth in 1989 to 184/1000 live birth in 1997.

Indication of inductionobstetricsmedicalAbruptio placentaeIUGRPost maturityRh isoimmunisationPROMSCongenital anomalyIUDOligohydramnios,polyhydramnios

Hypertensive disorders of pregnancyDiabetes mellitusChronic renal disease.Cholestasis of pregnancy

CONTRAINDICATIONS OF INDUCTION OF LABOURContracted pelvis and CPDMalpresentation (breech,tansverse lie or oblique lie)Previous classical caesarean section or hysterotomyUteroplacental factors: Unexplained vaginal bleeding,vasa previa,placenta previaActive genital herpes infection

ContdHigh risk pregnancy with fetal compromiseHeart diseasePelvic tumorElderly primigravida with obstetric or medical complications.Umbilical cord prolapseCervical carcinoma

PARAMETERS TO ASSESS PRIOR TO INDUCTION OF LABOURMATERNALFETALTo confirm the indication for IOL.Exclude the contraindication of IOL.Asses BISHOP SCORE (Score >6 favourable)Perform clinical pelvimetry to assess pelvic adequacyAdequate counselling about the risks,benefits and alternatives of IOL with the woman and the family membersTo ensure fetal gestatonal age.To estimate fetal weight.Ensure fetal lung maturation status.Ensure fetal presentation and lieConfirm fetal well being.

FACTORS FOR SUCCESSFUL INDUCTION OF LABOURParityPeriod of gestationPreinduction scoreSensitivity of uterus :positive oxytocin sensitivity test is favourable for IOL.Cervical ripening Presence of fetal fibronectinin vaginal swab ( >50ng/ml)

Induction of labour two componant

Bishops score 1964parametersscore0123Cervical dilatationclosed1-23-45+Effecement(%)0-3040-5060-7080consistancyfirmmediansoftpositionposteriormidlineanteriorstation-3-2-1,0+1, +2

Score 0-5 is unfavourable and 6-13 is favourable

Calder modification 1974 is effecement of cervix with length of cervixCervical length(cm)42-41-250ng/ml)

INDUCTION OF LABOUR IN SPECIAL SITUATIONS

Failed inductionIt is define when cervix failed to dilate 3-4 cm in 24 hours of induction. what to do now??????....

option to wait if no PROM and postponement is not harmful for fetus as well as mother . review the case if there is urgency caesarean section to be done.

Risks of inductionFailure of inductionPrematurityAbnormal uterine actionFetal hypoxiaAmniotic fluid embolism

RESULTS OF INDUCTIONProximity to termCondition of the cervixMethod of inductionStation of presenting partAmount of liquor drained

AUGMENTATION OF LABOURIntroduced by ODriscoll & his colleagues in 1968Term ACTIVE refers to the active involvement of the consultant-obstetrician in the management of primigravid labour.

When to augment ?Dilatation does not increase @ 1cm/hr.HOW AUGMENTATION IS DONE?A standard concentration of 10u of oxytocin is used in all circumstances.Rate of infusion begins @ 10drps and increases by 10 drps at interval of 15 mins to a maximum of 60 drops.

Conditions to be fulfilled before augmentationMothers must be nulliparous.Vertex presentation.Fetus must be single.Memranes must be ruptured.No evidence of fetal distress must be seen.The progress of labour charted on a partograph.Every mother not close to an easy vaginal delivery after 12hrs to be delivered by cesarean section.

AIM:To expedite delivery within 12hrs without increasing maternal morbidity and perinatal hazards.Objectives:Early detection of any delay in labour.Diagnose its cause.Initiate management.

COMPONENTS OF ACTIVE MANAGEMENT OF LABOURPrenatal education.Admission to LR only after the diagnosis of labour.Partographic monitoring of labour.ARM with confirmation of labour.Oxytocin augmentaion if cervical dilatation