CLINICAL TEACHING

ON
SURGICAL
INDUCTION OF
LABOUR

Submitted to: Submitted by:

Mrs. Sharanjit Kaur Simran pal Kaur
Lecturer M.Sc. Nursing 1st yr
UCON, Faridkot UCON, Faridkot

SURGICAL INDUCTION OF LABOUR

Definition: Assisting in initiation of labour or uterine contraction by artificial means before the onset of
spontaneous labour.

Purpose of induction of labour: When the risks of continuation of pregnancy, either to the mother or to the
fetus is more, induction is indicated. Before induction one must ensure the gestational age as well as
pulmonary maturity of the fetus.

Indication:
1. Maternal
i) Post-term pregnancy
ii) Hypertension including pre-eclampsia and eclampsia
iii) Medical problems-renal, respiratory and cardiac disease
iv) Previous stillbirth
v) Premature rupture of membranes
vi) Chronic polyhydrominos and maternal distress

2. Fetal
i) Placental insufficiency
ii) Rh-isoimmunization
iii) Unstable lie, after correcting into longitudinal lie
iv) Intrauterine death
v) Certain congenital anomalies
vi) Postmaturity

3. Combined Indications
i) Pre-eclampsia and eclampsia
ii) Minor degree of placenta previa
iii) Abruption placentae
iv) Chronic hypertension
v) Premature rupture of membranes

Contraindications:
1. Contracted pelvis and cephalopelvic disproportion
2. Persistent malpresentation-transverse or compound presentation
3. Pregnancy with history of previous cesarean section
4. Elderly primigravida
5. High-risk pregnancy with compromised fetus
6. Cord presentation or cord prolapse.
7. Placenta previa
8. Pelvic tumor
9. Heart disease

Dangers of Induction of Labour:

Maternal Fetal
 Psychological upset, more so, when there is  Iatrogenic prematurity
failure and caesarean section is done.  Hypoxia due to disordered uterine
 Tendency of prolonged labour due to action, prolonged labour and
abnormal uterine action. operative interference.
 Increased need of analgesia during labour.
 Increased operative interference.
 Increased morbidity.

Methods of induction:
1. Medical
 2. Surgical
3. Combined

Surgical Induction: Surgical induction of labour is done by two methods:

1. Artificial rupture of membranes (ARM):
 Low Rupture of Membranes (LRM)
 High Rupture of Membranes (HRM)- Obsolete
2. Stripping of membranes

Mechanism of Onset of Labour: May be related with

1) Stretching of the cervix
2) Separation of the membranes
3) Reduction of amniotic fluid volume

Effectiveness depends on:

1) State of the cervix
2) Station of the presenting part

Advantages of Amniotomy:
1) High success rates
2) Chance to observe the amniotic fluid for blood or meconium
3) Access to use fetal scalp electrode or intrauterine pressure catheter or for fetal scalp blood sampling.

Limitation: It cannot be employed in an unfavourable cervix (long, firm cervix with os closed). The cervix
should be at least one finger dilated.

Contraindications: Intrauterine fetal death, Maternal AIDS, Genital active herpes infection
Articles Needed: A sterile tray containing:
 Sterile Gloves
 Gown
 Mask
 Savlon Swabs
 Kocher’s Forceps
 Antibiotic Prescribed
 Kidney Tray

S.No Steps Rationale

1 Wash hands using surgical asepsis. Prevents risk of infection.
2 Help the mother to lie down in lithotomy position. Ensures better visualization.
3 Follow strict aseptic technique Reduces chances of infection.
4 Wear sterile gloves, gown and mask
5 Clean the perineum using aseptic technique.
6 Physician introduces two figure of left hand inside the Helps to guide the ARM forceps.
vagina, up to the cervical canal and beyond the internal os.
7 Physician assesses the membranes, and places palmar Guiding hand will prevent injury to the
surface of the left hand upward. cervix or vaginal tract.
8 Physician introduces a long Kocher’s forceps with blades
closed up to the membranes along the palmar aspect and
ruptures the membranes.
9 Record the date and time and the type of induction done. Acts as a communication between staff
members.

After the membranes rupture, the following are to be assessed

 A. Colour of the amniotic fluid
B. Status of the cervix
 C. Station of the head
D. Detection of cord prolapse, if any.
E. Quality of FHR
 A sterile vulval pad is placed. Prophylactic antibiotic may be prescribed

Hazards of ARM:
1. Intrauterine infection, particularly iatrogenic from digital or instrumental contamination.
2. Chance of umbilical cord prolapse.
3. Bleeding from the following sources:
a) Fetal vessels in the membranes incase of vasa-previa.
b) The friable vessels in the cervix.
c) A low lying placental site.
4. Amniotic fluid embolism.
5. Injury to the cervix or the presenting part.

STRIPPING THE MEMBRANES

Stripping of the membranes means digital separation of the chorioamniotic membranes from the wall of the
cervix and lower uterine segment. It is thought to work by release of endogenous prostaglandins from the
membranes and decidua. Manual exploration of the cervix triggers Ferguson reflex which promotes oxytocin
release from maternal pituitary. Sweeping of the membranes is done prior to ARM. It is simple, safe and
beneficial for induction of labour.
As an isolated procedure, stripping the membranes off from its attachment from the lower segment is an
effective procedure for induction provided cervical score is favourable. It is used as a preliminary step prior
to rupture of the membranes. It is also used to make the cervix ripe.

BIBLIOGRAPHY
 Dutta D.C., “Text book of obstetrics”, Sixth Edition, Published by “New Central Book Agency”,
Page No. 520, 523-525
 Jacob Annamma, R Rekha, Tarachand Sonali Jadhav, “Clinical Nursing Prodecures: The Art of
Nursing Practice”, Published by Jaypee Publishers