CLASS PRESENTATION

ON
INDUCTION OF LABOR
b vn v
Presented by
Lipika Chel
4th year B. Sc.
Nursing Student
BSMC,Bankura
Introduction
Definition
Induction of labor (IOL)means initiation of Uterine
contraction (after the period of viability)by any method
(medical,surgical or combined)for the purposes of vagina
delivery.

Augmentation of labour is the process of stimulation

of uterine contraction (both in frequency and
intensity) that are already present but found to be
inadequate.
INDICATION FOR IOL
Postmaturity
Pre-eclampsia/eclampsia
Intrauterine fetal death
Premature rupture of the membranes
Congenial malformation of the fetus
Antepartum hemorrhage
Chronic hydramnios
 Cont...
Maternal Medical Complication:
Diabetes mellitus
Chronic Renal Disease
Cholestatis of pregnancy
IUGR
Rh-isoimmunization
Maternal request
Contraindications of IOL
Contracted pelvis and cephalopelvic disproportion
Malpresentation
Previous classical cesarean section or hysterotomy
(scarred uterus)
Uteroplacental factors:
Unexplained vaginal bleeding
Placenta previa .
Cont...
Active genital herpes infection .
High-risk pregnancy with fetal compromise.
Heart disease.
Pelvic tumor.
Elderly primi gravida with obstetric or medical
complications.
Umbilical cord prolapse.
Cervical carcinoma.
Dangers of Induction Of Labor
Tendency of prolonged labor due to abnormal uterine
action
Psychological upset when there is induction failure and
cesarean section is done
Excessive uterine contraction
Uterine Rupture
Risk of PPH
Fetal
Hypoxia due to uterine dysfunction
Laterogenic prematurity
Parameters to be assessed prior to
induction
Maternal:
To confirm the indication for IOL
Exclude the contraindications of IOL
Assess bishop score(score >6, favorable)
Perform clinical pelvimetry to assess the pelvic adequacy
Adequate counseling about the risks ,benefits and
alternatives of IOL
Counseling for the need of cesarean delivery in case of
failure of induction
Cont...
Fetal:
To ensure fetal gestational age
To estimate fetal weight by USG estimation
Ensure lung maturity status
Ensure fetal presentations and lie
Confirm fetal well-being
Cervical Ripening:-
Cervical Ripening is a series of complex biochemical
changes in the cervix which is mediated by the
hormones.There is alteration of both cervical collagen
and ground substances. Ultimately,the cervix becomes
soft and pliable.
Bishop’s Preinduction Cervical scoring system
Method of Cervical Ripening
Pharmacological Methods
1. Oxytocin
2. Prostaglandin
3. Progesterone Receptor Antagonist
4. Relaxin
5. Hyaluronic Acid
Cont..
Non-pharmacological Methods
Mechanical Methods :
Mechanical Dilators
Foley catheter(Single Ballon)
Transcervical Ballon catheter
Extra amniotic saline Infusion
Osmotic (hygroscopic)dilators,
Laminaria tents
TRANSCERVICAL BALLON CATHETER
EXTRA AMNIOTIC SALINE INFUSION
HYGROSCOPIC DILATOR
HYGROSCOPIC DILATOR
Methods Of Cervical Ripening
Surgical Methods:
1. Sweeping of membranes
2. Amniotomy(Artificial Rupture of Membranes)
METHODS OF INDUCTION OF LABOR:
Medical
Surgical
Combined
MEDICAL INDUCTION:
Drug used:
• Prostaglandin (PGE2 , PGE1)
• Oxytocin
• Mifepristone
Prostaglandin (PGE-2, PGE-2a)
 PGE2 is primarily important for cervical ripening
 PGE-2a for myometrial contraction.
 PGE-2a has greater collagenolytic properties and also
sensitizes the myometrium to oxytocin

PGE2(tablet,gel or controlled release pessary) should be used as

the first-line agent.
Application of Dinoprostone gel
Side effects
Shivering
Backache
Vomiting
Diarrhea
Shortness of breath
Uterine rupture
Controlled release pessary
Misoprostol(PGE1)
 Misoprostol (PGE1) is currently being used either
transvaginally or Orally for induction of labor.
 A dose of 25 microgram vaginally every 4hours(6-8 doses
are used)
 Side effects:Tachysystole, meconium passage and possibly
uterine rupture
 Contraindication: women with previous cesarean birth
Oxytocin
Oxytocin is an endogenous uterotonic that stimulates uterine
contraction.
Receptor concentration increase during pregnancy and
in labor.
Oxytocin acts by (a)Receptor mediation;(b)voltage-mediated
calcium channels and (c )Prostaglandin production
Oxytocin is effective for induction of labor when the cervix is
ripe.but it is less effective as a cervical ripening Agent.
Low dose: 0.1 and <4mU/min
High dose: betwen 1.0 and 6mU/min
Dose is increased in every 20-30 min.
Side effects
 Water intoxication
 Heart failure
 Headache, nausea, vomiting
 Decrease urine output
 Hypotension
 Tachycardia
Mifepristone(Progesterone receptor
antagonist)
Blocks both progesterone and glucocorticoid
receptors.200mg vaginally daily for 2 days has been found to
ripen the cervix and to induce labor.
Surgical Induction
Methods:
1. Artificial rupture of the membrane(ARM)
2. Low rupture of the membranes(LRM)
3. Stripping/Sweeping the membranes.
Artificial Rupture Of The Membrane
Mechanism of onset of labor:- May be related with
(A) Stretching of the cervix.
(B) Separation of the membranes(Release of Prostaglandins).
(C) Reduction of amniotic fluid volume .
Effectiveness depends on:
1. State of the cervix.
2. Station of the presenting part
Induction delivery interval is shorter when amniotomy is
combined with the oxytocin
Advantage of amniotomy:
High success rate
Chance to observe the amniotic fluid for blood and
meconium
Access to use fetal scalp electrode or for fetal scalp blood
sampling
Limitations :-
It cannot be employed in an unfavorable
cervix(long,firm,cervix with os closed).The cervix should
be atleast one finger dilated
INDICATION
Abruptio placenta
Chronic hydramnios
Severe pre-eclampsia/eclampsia
In combination with medical inducton
To place scalp electrode for electronic fetal monitoring.
Contraindications
Intrauterine fetal death(IUFD)
Maternal AIDS
Genital active herpes infection
Immediate beneficial effects of ARM
Shortens the duration of labor
Lowering of the blood pressure in Pre-eclampsia and
eclampsia cases
Relief of Maternal distress in hydramnious
Control of bleeding in APH
Relief of tension in abruptio placenta and initiation of
labor
Hazards of ARM
 Once the procedure is adopted,there is no scope of
retreating from the decision of delivery
 Chance of umbilical cord prolapse
 Amnionitis
 Accidental injury
 Liquor amnii embolism (rare)
LOW RUPTURE OF MEMBRANE
Contraindication
Woman with HIV infection
Women with group B streptococcus infection
Chronic hydramnios
Steps
After procedure following should be checked
STRIPPING THE MEMBRANES
Stripping (sweeping)of
the membranes means
digital separation of the
chorioamniotic
membranes from the
wall of the cervix and
lower uterine segment.
Critera to be Fulfilled for Membrane
Stripping
1 .The fetal head must be well applied to the
cervix.
2.The cervix should be dilated so as to allow the
introduction of the examiner’s finger.
COMBINED METHOD
The advantage of combined method

1. More effective than any single procedure

2. Shorten the induction delivery interval and
thereby –(a) minimizes the risk of infection (b)
lessens the period of observation.
ACTIVE MANAGEMENT OF LABOR
The term “active” refers to the active involvement of the
consultant obstetrician in the management of primigravid labor.
 Active management applies exclusively to primigravidas with
singleton pregnancy and cephalic presentation who are in
spontaneous labor and with clear liquor.
 Husband or the partner is present during the course.
 partograph is maintained to record the progress of labor
The essential component of AMOL
Antenatal classes to explain the purpose and the procedure of
AMOL.
Woman is admitted in the labor ward only after the diagnosis of
labor.
One -to-one Nursing care with patographic monitoring of labor.
Amniotomy with confirmation of labor.
 Oxytocin augmentation if cervical dilatation is <1cm /hr
Delivery is completed within 12 hours of admission
Epidural analgesia if needed
Fetal monitoring by auscultation
Active involvement of the consultant obstetrician.
Aim:
To expedite delivery within 12hrs without increasing
maternal morbidity and perinatal hazards.
Objective
Early detection of any delay in labor.
Diagnose it’s cause.
Initiate management.
Advantage
Less chance of dysfunctional labor.
Shortness the duration of labor (<12 hours).
Fetal hypoxia can be detected early.
Low incidence of cesarean birth.
Low analgesia.
Less Maternal anxiety due to support of the caregiver
and prenatal education.
Contra-indication
Presence of obstetrics complication.
Presence of fetal compromise.
Multi gravida.
Limitations of active management of
labor
It is employed in selected cases and in selected centre
where monitoring by trained personnel.
It requires more staff involvement in the antenatal
clinic and labor ward.
 PARTOGRAPH
Partograph is composite
graphical presentation of
all event of labor including
Maternal condition,fetal
condition and progress of
labor against time on a
single sheet of paper.
Advantage of Partograph:
A single sheet of paper can provide details of necessary
information at a glance
No need to record labor events repeatedly
Predict deviation from normal Progress of labor
Facilitates handover procedure
Induction of partograph in the management of labor
has reduced the incidence of prolong labor and
cesarean section
Previous Question
Define Induction of Labour
What are the parameters to be assessed before IOL?
Describe the various methods of Induction of labour.
Describe the role of nurse during IOL (2015,2018)