INDUCTION OF LABOUR

Induction of labour may be indicated for medical reasons, like, pre-eclampsia, diabetes, post-term pregnancy.

However, possible risks of induction are:

  • Failed induction
  • Hyperstimulation syndrome, requiring emergency caesarean section.

Induction is contraindicated in para 5 and above and in patients with a previous scar. In these cases there is
indication for caesarean section.

TREATMENT

Cervix favourable in HIV and Hep B negative mothers

  • Artifically rupture the membranes (with amniotic hook or Kocher clamp) followed 2 hours later by
  • Oxytocin IV 2.5 IU in 500 mL of Normal saline. Start with 10 drops/minute
  • Increase infusion rate by 10 drops every 30 minutes (max 60 minutes) until good contraction
    pattern is established (3-5 contractions in 10 minutes each lasting >40 secs), and maintain
    until delivery is complete
  • If no good contraction pattern with 60 drops/minute, increase oxytocin concentration to 5 IU in 500 mL of Dextrose or Normal saline at 30 drops/minute, increase by 10 drops every 30 minutes until maximum of 60 drops/minute
  • ONLY IN PRIMIGRAVIDA: if no good contraction pattern established, increase concentration of oxytocin to 10 IU in 500 mL and repeat as above (from 30 to 60 drops/minute)
  • DO NOT USE 10 IU in 500 mL in MULTIGRAVIDA or WOMEN WITH PREVIOUS CAESAREAN SECTION
  • Refer other cases or primigravida not responding to the higher concentration for surgical
    management
  • NEVER LEAVE THE WOMAN ALONE

If >4 contractions in 10 minutes, or contraction longer than 60 secs or foetal distress:

  • Stop rate of infusion
  • Give salbutamol 5 mg in RL or NS 500 mL IV
    infusion at 10 drops/minute
  • Monitor foetal heart rate

Cervix not favourable

  • Ripen cervix using either
  • Misoprostol 25 micrograms inserted vaginally every 6 hours for 2 doses, if no response increase to 50 micrograms every 6 hours, max 200 micrograms in 24 hours – stop when in established labour
  • Or misoprostol 20 micrograms orally (dissolve 1200 microgram tablet in 200 mL of water and give
    20 mL) every 2 hours until labour starts or max 24 hours
  • Or Foley catheter: insert Foley catheter through internal cervical os under sterile technique,
    inflate bulb with 50 mL of water, and tape catheter under light traction, leave it until contraction
    begins or up to 12 hours
  • If cervical ripening, proceed to cesarean section
  • If cervix ripens but labour does no start, start oxytocin induction
Caution
  • Do not start oxytocin within 8 hours of using misoprostol
  • Carefully control oxytocin infusion – do not give rapidly
  • Monitor uterine contractions and foetal heart rate closely
  • If foetal distress, do emergency cesarean section