UTERINE STIMULANT

(non pharmacology)

RAWAN METAP ALRWATHE

(MCH)

INTRUDUCTION
INDUCTION OF LABOR: is a procedure used to
stimulate uterine contractions during pregnancy before labor begins on its own. Successful labor induction leads to 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 .

INDICATIONS Of INDUCTION OF LABOR:

-Hypertensive disorders -Prolonged pregnancy(>42weeks most common) -Pre-eclampsia/eclampsia -Maternal medical conditions -Diabetes mellitus -Renal disease -Chronic pulmonary disease -Pre- labor rupture of membranes -Chorioamnionitis -Fetal compromise -Fetal demise

CONTRAINDICATIONS:
(Contraindications to labor or vaginal delivery)

Severe degree CPD Major degree placenta praevia Transverse lie Previous classical CS,Myomectomy Previous>= 2 LSCS Grand multiparity Active genital herpes Hypersensitivity to inducing agent RISKS OF INDUCTION:
Failure leading to CS Uterine hyperstimulation Fetal distress,death Rupture uterus Intrauterine infection,sepsis Iatrogenic delivery of preterm infant Precipitate/dysfunctional labour Inc. risk of operative vaginal delivery Inc. risk of birth trauma , Inc. risk of PPH
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METHODS INDUCTION OF LABOR:

Non pharmacology methods:

Natural methods:
- SEXUAL INTERCOURSE
-HERBAL SUPPLEMENTSP: Commonly prescribed agents

include evening primrose oil, black haw, black and blue cohosh, and red raspberry leaves. Although evening primrose oil is the remedy most commonly used by midwives.

-HOT BATHS, AND ENEMAS. -NIPPLE STIMULATIONP: Nipple stimulation produces

oxytocin and can produce some strong effects, so you can try stimulating your nipples (including your areola, as a baby would when sucking) with your fingers, massaging one at a time

-ACUPUNCTURE .

- WALKING. -MASSAGE.

Mechanical methods: 1-Stripping of the Membranes:

Stripping of the membranes causes an increase in the activity of phospholipase and prostaglandin as well as causing mechanical dilation of the cervix, which releases prostaglandins.

Procedure:

The membranes are stripped by

inserting the examining finger through the internal cervical os and moving it in a circular direction to detach the inferior pole of the membranes from the lower uterine segment.
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Risk: infection Bleeding - accidental rupture of the

membranes maternal discomfort.

Timing: -Primi 40-41 weeks -Multi 41 weeks

Advantage - makes spontaneous onset of labour more likely. - Reduces the need for formal IOL.
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2-amaniotomy: stretching of the cervix & separation of the membranes release of Prostaglandins. -Depends on the state of the cervix and station of the presenting part. -ADV: -High success rate -chance to see the amniotic fluid -relief maternal distress ch. Hydramnios

CONTRAINDICATIONS: 1.IUD 2.HIV HAZARDS:

1.Cord prolapse 2.Amnionitis. 3.amniotic fluid embolism. 4.placenta abrupion. 5.fetal injury. 6.FHR deceleration.

3-Balloon catheters: use today usually

employ a single- or double ballooncatheter. Compared with prostaglandins or oxytocin

-Procedure: -It is introduced into the cervical canal past

the internal os, the bulb is inflated with 30-60 cc of water. -It is left for up to 24 hrs or until it falls out

Advantages: -No difference in operative delivery rate, or

maternal or neonatal morbidity compared to PG gel . -May be useful for outpatient ripening -Can be inserted in presence or absence of membranes

-Associated with favorable Bishop scores and no

additional side effects. -The combination of balloon catheter plus oxytocin is recommended as an alternative method when
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prostaglandins (including misoprostol) are not available or are contraindicated (previous caesarean).

CONTRAINDICATIONS: -Low laying placenta.

-antepartum Hg. -ROM. -cervicitis.

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References:
-www.transitiontoparenthood.com/nancy/induction.htm -http://www.givingbirthnaturally.com/natura - n.wikipedia.org/wiki/Labor_induction -http://www.wikihow.com/Induce-Labor-Naturally

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