1 / 19

Induction of labor

Induction of labor. Dr. Yasir Katib MBBS, FRCSC, Perinatologest. Objectives. Basic principles Indications and contraindications of induction of labour Methods of induction Prediction of success Induction after cesarean. Histology.

griffith-fields
Download Presentation

Induction of labor

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Induction of labor Dr. Yasir Katib MBBS, FRCSC, Perinatologest

  2. Objectives • Basic principles • Indications and contraindications of induction of labour • Methods of induction • Prediction of success • Induction after cesarean

  3. Histology • The fundus is composed of myometrium, predominantly smooth muscle cells and the endometrium • The normal pregnant cervix is 3.5 cm or longer and is composed predominantly of connective tissue, mainly collagen. In contrast to the fundus, it has only 10-15% smooth muscle

  4. Introduction • Definition It is an iatrogenic stimulation of uterine contractions to accomplish delivery prior to the onset of spontaneous labor • Induction of labour is done when the benefits of expeditious delivery outweigh the potential maternal or fetal risks of the procedure • Rate 15-25%

  5. Indications • Either maternal or fetal indications with the following criteria : • Continuing the pregnancy is believed to be associated with greater maternal or fetal risk than intervention to deliver the pregnancy • There is no contraindication to vaginal birth

  6. Indications Examples of common and • Obstetrical conditions • postterm pregnancy • prelabor (premature) rupture of membranes • intrauterine fetal growth restriction • fetal demise • Medical conditions • preeclampsia/eclampsia • GDM on insulin

  7. Gestational Age at Induction

  8. Gravidity

  9. Parity

  10. Concerns Major concerns • Increase rates of cesarean delivery • Iatrogenic prematurity • Cost • Neonatal safety • Maternal safety • Infection

  11. Contra-indications Absolute • Prior classical uterine incision • Prior transmural uterine incision entering the uterine cavity • Active genital herpes infection • Placenta or vasa previa • Umbilical cord prolapse • Transverse fetal lie Relative (with caution) • previous low transverse cesarean delivery • multifetal pregnancy

  12. Methods of induction • Mechanical • Membrane sweep • Artificial rupture of membrane • Balloon catheter • Laminaria • Hormonal • Prostaglandin • Oxytocin • Natural methods • Caster oil

  13. Induction of labour

  14. Methods of Induction

  15. Cervical ripening • Associated with cervical ripening is an increase in the enzyme cyclooxygenase-2, which leads to a local increase of prostaglandin E2 (PGE2) in the cervix that led to: • Dilatation of small vessels in the cervix • Increase in collagen degradation • Increase in hyaluronic acid • Increase in chemotaxis for leukocytes, which causes increased collagen degradation • Increase in stimulation of interleukin (IL)–8 release

  16. Bishop score

  17. PREDICTING A SUCCESSFUL INDUCTION Using Bishop score • Score < 5 suggests further ripening is needed • Score 5-7 is equivocal • score >7 suggests that ripening is completed

  18. Type of Delivery

  19. Induction after cesarean • Induced labor after cesarean delivery have a 2- to 3-fold increased risk of cesarean delivery compared with those who present with spontaneous labor • Associated risks: • Rupture of uterus • Emergency cesarean

More Related