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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 .

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Induction of labor

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  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

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