INDUCTION OF LABOR

INTRODUCTION: Induction of labour is the artificial stimulation of uterine contractions

by using drugs before the onset of the labour spontaneously. For some women drugs, given
to stimulate the uterine contraction .The nurses working in labor and delivery room must
have a good understanding of uterine stimulants. It is an obstetrical intervention that should
be used when elective birth
DEFINITION: It is a procedure where pregnancy is deliberately terminated after 28weeks of
pregnancy, as a matter of urgency , either for the mother or the fetus , by any method medical
, surgical or combined , which aims at initiation of labor and vaginal delivery .
PURPOSES OF PROCEDURE : To prevent the risk of continuation of pregnancy either to
the mother or to the fetus.
INDICATIONS OF INDUCTION OF LABOR:
MATERNAL
1. Hypertensive disorders of pregnancy (pre-eclampsia, eclampsia, chronic
hypertension).
2. Maternal medical complications like diabetes mellitus, chronic renal disease, chronic
pulmonary diseases.
3. Post term pregnancy.
4. Previous still birth.
5. Premature rupture of membranes.
6. Chronic polyhydramnios, oligohydramnios.
FETAL
1. Post maturity.
2. Rh-isoimmunization.
3. Unstable lie, after correction into longitudinal lie.
4. Certain congenital anomalies.
5. Intrauterine death.
6. Placental insufficiency.
COMBINED INDICATIONS:
1. Minor degree of placenta previa.
2. Chronic hypertension.
3. Premature rupture of membranes.
4. Abruptio placenta.
5. Pre-eclampsia and eclampsia.

CONTRAINDICATIONS OF PROCEDURE:
1. Contracted pelvis and cephalopelvic disproportion.
2. Persistent malpresentation- transverse and compound presentation.
3. Pregnancy with history of previous cesarean section.
4. Cord presentation or cord prolapse.
 5. Placenta previa.
6. Pelvic tumor.
7. Elderly primigravida
8. High risk pregnancy with compromised fetus.
METODS OF INDUCTION:
1. Medical
2. Surgical
3. Combined
ARTICALS :
 Handwashing articles for cleaning hands to prevent infection.
 Screen for maintaining privacy.
 Spot light for proper visualization of vein for insertion of veinflon.
 Stethoscope.
 Mask,apron and sterile gloves to maintain asepsis and prevent cross infection.
A Tray containing following items:
 Small mackintosh to prevent soiling of bed sheet.
 Articles for cleansing the skin- Antiseptic solution ,adhesive plaster, sterile cotton
swabs, kidney tray.
 Veinflon for infusion of oxytocin in normal saline.
 A sterile iv set for giving oxytocin solution.
 Disposable syringes(2cc& 5cc).
 Distilled water for oxytocin preparation.
 Normal saline for preparing oxytocin solution for induction of labor.
 Kocher forcep in case of surgical induction.
 Medication like Oxytocin/cereviprime/Mifepristone.
MEDICAL METHOD OF INDUCTION:
STEPS OF PROCEDURE IN INDUCTION OF LABOR BY OXYTOCIN:
Preprocedural steps:
 Ask mother to void to empty the bladder and make her comfortable before procedure.
 Check the fetal heart rate ,uterine contraction rate , abdominal and vaginal finding
before the induction.
 Prepare the perineal area to minimize the infection.
 Check written order carefully to avoid any mistake.
 Keep all the articles ready to save the time .
 Explain the procedure to reduce the anxiety of mother.
 Wash hands to prevent cross infection.
Intraprocedural Steps:
 Place the mackintosh under the mother’s arm.
 Setup the IV tubing,and adjust the drops/min.
 Add the loaded oxytocin in IV bottle after accurate dose calculation,prescribed by the
doctor.
Postprocedural steps:
 Observe uterine contraction for intensity,duration,and frequency.
 Record fetal heart sound throughout the course of drip.
 Watch for vital signs of mother.
 When strong contraction lasting over 60sec. and occurring frequently with intervals<3
min.tonic uterine contraction, fetal distress,occurrence of decreased and increased
fetal movement, nad notify immediately to doctor.
 Gradually increase the drops after prescription of doctor ensuring that everything is
normal.
STEPS OF PROCEDURE IN INDUCTION OF LABOR BY PROSTAGLANDIN:
 To maintain good IPR before doing procedure.
 Check the written order carefully.
 Keep all the articles ready to save time.
 Explain the procedure to the mother to reduce anxiety.
 Wash hands to prevent infection.
 Provide privacy to reduce anxiety.
Intraprocedural step:
 Assist the doctor to insert prostaglandin(misoprostal) gel into the posterior fornix
close to cervix.
Postprocedural steps:
 Advice the women to stay recumbent as contration begin.
 Observe uterine contraction for intensity duration ,and frequency .
 Record fetal heart sound.
 Watch for vital signs of mother.
 Doctor must be notified immediately for abnormal observation.
SURGICAL METHOD OF INDUCTION:
Articles:
 Sterile tray.
 Bowl and swabs.
 Sponge-holding forceps.
 Kocher forcepe(to rupturethe membrane).
 Kidney tray.
 Perineal pads.
Preprocedural steps:
 Approach the women pleasantly to establish rapport.
 Check written order carefully to avoid any mistake.
 Keep all the articles ready to save time.
 Explain the procedure to the mother to reduce anxiety.
 Wash hands to prevent cross infections.
 Provide privacy to reduce anxiety.
Intraprocedural steps:
  Wear sterile gloves ,gown and mask.
 Clean the perineum using antiseptic solutions.
 The index fingeris passed through the cervical canal beyond the inernal os.
 Physician assesses the membranes, and places palmer surface of the lefthand upwards.
 Physician introduces a long kocher’s with blades closed up the membranes along the
palmer aspect and ruptures the membranes.
Postprocedural steps:
 Observe uterine contraction for intensity duration,frequency.
 Record fetal heart sounds/
 Watch vital signs in mother.
 Assess fetal heart rate,mote the color, amount of the amniotic fluid, stats of
cervix,station of head, and presenceor absence or cord prolapsed.
 Doctor must be notified immediately for abnormal observation.