SlideShare una empresa de Scribd logo
1 de 21
Descargar para leer sin conexión
CASE
A 24 year old Puan Nina was admitted to hospital on 8th August at
8.50 am for the induction of labour for post maturity, her
pregnancy gestation is 40 weeks and 1 day.
Previous Obstetric history:
Gravid 3, Para 2, two previous normal deliveries. No history of any
medical problems and no problems identified in this pregnancy.
At 8.50am admitted to the Labour ward, no signs of labour on
admission and the findings from the vaginal examination were
that the cervix was 2 cm dilated. Decision was made to do an ARM
(artificial rupture of membranes) and to commence Syntocinon.
CASE
The woman progressed well in labour and had a normal
delivery of a female infant at 1.19pm, The infant's
weight was 3.5kg, Apgar scores were 9 at 1 & 5 minutes.
INDUCTION
OF
LABOR
CLINICAL CASE DISCUSIÓN
BY AFIQI
DEFINITIONS
Induction of Labor (IOL) is defined as artificial initiation
of uterine contractions before the spontaneous onset
of labor.
Augmentation of labor refers to stimulation of
spontaneous contractions that are considered
inadequate because of failed cervical dilation and fetal
descent.
INDICATION
FOR INDUCTION
11
1. pre-eclampsia, eclampsia,
chronic hypertension > 37wks
2. Diabetes, renal disease,
chronic pulmonary disease
3. Premature rupture of
membranes
4. Chorioamnionitis
5. Fetal growth restriction
6. Rh isoimmunization
7. Postdated pregnancy
8. Fetal demise
9. Abruptio placentae
10.Fetal malformations
incompatible with life
11.Logistic factors: Risk of rapid
labor, distance from hospital,
psychosocial indications
CONTRAINDICATION
OF INDUCTION
11
1. Placenta praevia or Vasa praevia
2. Cord presentation
3. Abnormal fetal lie/ presentation
4. Cephalopelvic disproportion because of malpresentation or abnormal
pelvic bone structure
5. Active genital Herpes infection
6. Invasive cervical carcinoma
7. Hypersensitivity to cervical ripening agents
8. Previous uterine rupture
CONTRAINDICATION
OF INDUCTION
11
1. Multiple pregnancy
2. Polyhydramnios
3. Grand multiparity
4. Maternal heart disease.
5. Severe hypertension.
6. Breech presentation
7. One or more previous cesarean section
8. Abnormal fetal heart rate not requiring emergency cesarean section
CONDITIONS WHERE IOL IS NOT A TRUE CONTRAINDICATION BUT WHERE SPECIAL
CAUTION IS REQUIRED :
1
RISK OF IOL
MATERNAL RISKS
I. Failure leading to Cesarean section
II. Uterine hyperstimulation
III. Rupture uterus
IV. Intrauterine infection, Chorioamnionitis
V. Amniotic Fluid Embolism
VI. Precipitate labor , Dysfunctional labor
VII.Increased risk of operative vaginal delivery
VIII.Increased risk of post partum hemorrhage
IX. Abruptio Placentae
X. APH from undiagnosed placenta praevia
XI. Water intoxication
1
RISK OF IOL
FETAL RISKS
I. Fetal distress .
II. Fetal death
III. Neonatal sepsis
IV. Iatrogenic delivery of a preterm infant
V. Cord prolapse
VI. Neonatal jaundice
VII.Increased risk of birth trauma
PRE- REQUISITES
FOR IOLI. Evaluate the indication
II. Explain the indication to the patient + details of the method to
be used and take a written informed consent
III. Assess adequacy of the pelvis and fetal size
IV. Confirm the gestational age, fetal lie, and assess the fetal lung
maturity # where ever indicated
V. Uterine activity and FHR should be continuously monitored. In
case of clinical auscultation, FHR should be heard during and for
30 seconds after a contraction at least every 15 minutes during
the active phase of labor and after every contraction in the
second stage
VI. Partogram is to be maintained for active labour
VII.Trained personnel and well equipped center
PRE INDUCTION CERVICAL
ASSESSMENT:
Modified Bishop’s Preinduction cervical scoring system: to determine the
suitability of a patient for IOL in patients who were parous, at term , had an
uncomplicated pregnancy and the fetus was in cephalic presentation.
FACTOR 0 1 2 3
Dilatation (cm) 0
(closed)
1 – 2 3 – 4 5
Length (cm) >4 3 – 4 1 – 2 0
Position Posterior Midline Anterior -
Consistency Firm Medium Soft -
Head: station -3 -2 -1 , 0 +1 , +2
Score
Total Score =13
Favourable Score= 6-13
Unfavourable Score= 0-5
METHODS OF CERVICAL
RIPENING AND IOL
Methods for cervical ripening and labor induction can be broadly
classified as :
PHARMACEUTICAL
MECANICAL
SURGICAL
METHODS OF CERVICAL
RIPENING AND IOL
MECHANICAL
• Sweeping of membrane
Membrane stripping at term shortens the interval of time to onset of
spontaneous labor and reduces the need for formal induction.
• Foley's catheter
This uses the same mechanism as sweeping but the inflated bulb of Foley’s
results in release of endogenous prostaglandins and initiates labor.
METHODS OF CERVICAL
RIPENING AND IOL
• Exogenous Prostaglandins
Prostaglandins (E2) are effective for both cervical ripening and- labor
induction. Prostaglandin E2 are typically administered intravaginally for
cervical ripening as the first step in labor induction. They are administered
as gel, tablet or controlled release pessary.
The recommended regimens are:
 One cycle of vaginal PGE2 tablets one dose 3mg in a nulliparous and 0.5
mg in a multipara, followed by second dose after 6 hours if labor is not
established . Maximum of 2 doses in a cycle.
 One cycle of vaginal PGE2 controlled release pessary one dose over 24
hours.
PHARMACEUTICAL
METHODS OF CERVICAL
RIPENING AND IOL
intravaginal PGE2 are the preferred method of induction of labor,
unless there are any specific indications for not using it like the
risk of uterine hyperstimulation.
Prostaglandins PGEl – Misoprostol
Although studies have demonstrated that misoprostol is an
effective agent in induction of labor, there are concerns regarding
its safety and until the best dosage regimen is determined, its use
in labor induction is confined to clinical trials.
PHARMACEUTICAL
induction of labor - A Clinical Case Discussion
METHODS OF CERVICAL
RIPENING AND IOL
 Oxytocin
Increase in responsiveness with advancing gestational age. Once spontaneous
labor begins the uterine sensitivity to endogenous oxytocin increases rapidly.
The dose is typically increased until there is normal progress of labor or strong
contractions occurring at 4 contractions per ten minutes and lasting for at
least 45 seconds. There is no benefit to increasing the dose after one of these
endpoints has been achieved. Continuous monitoring of uterine activity and
fetal heart rate are important once oxytocin is in use .
SURGICAL
METHODS OF CERVICAL
RIPENING AND IOL
 Amniotomy
It is an effective method of labor induction but can only be performed in
patients with partially dilated and effaced cervices.
The obstetrician should ensure that the fetal vertex is well-applied to the
cervix and the umbilical cord or other fetal part is not the presenting part.
The fetal heart rate before and after the procedure has to be documented and
the color of the amniotic fluid should be noted.
SURGICAL
CERVICAL RIPENING &
SUCCESSFUL INDUCTION
 Oxytocin is less effective for labor induction when used in
women with uneffaced and undilated cervices. Therefore, a
ripening process should be used prior to oxytocin induction
when the cervix is unfavorable.
 The two major methods are as follow:
I. Mechanical (physical) interventions, such as disruption
of the fetal membranes or insertion of dilators or a
balloon catheter.
II. Application of cervical ripening agents, such as
prostaglandin compounds.
COMPLICATIONS
 Hyperstimulation
 Fetal hypoxemia
 Hyponatremia
 Hypotension
 Hyponatremia
 Failed induction
 Uterine rupture
 Hyperbilirunemia
XIE XIE

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

presentaion on perineal tear
presentaion on perineal tearpresentaion on perineal tear
presentaion on perineal tear
 
Cervical incompetence
Cervical incompetenceCervical incompetence
Cervical incompetence
 
Cervical ripening and the bishop score
Cervical ripening and the bishop scoreCervical ripening and the bishop score
Cervical ripening and the bishop score
 
Intrauterine fetal death
Intrauterine fetal death Intrauterine fetal death
Intrauterine fetal death
 
Molar pregnancy
Molar pregnancyMolar pregnancy
Molar pregnancy
 
Ante partum haemorrhage with mcq
Ante partum haemorrhage with mcqAnte partum haemorrhage with mcq
Ante partum haemorrhage with mcq
 
Iufd by dr shabnam
Iufd by dr shabnamIufd by dr shabnam
Iufd by dr shabnam
 
Occipito posterior positition
Occipito posterior posititionOccipito posterior positition
Occipito posterior positition
 
Miscarriages
MiscarriagesMiscarriages
Miscarriages
 
Abnormal labour
Abnormal labourAbnormal labour
Abnormal labour
 
Prom and pprom
Prom and ppromProm and pprom
Prom and pprom
 
Malpresentations
MalpresentationsMalpresentations
Malpresentations
 
Preterm labour
Preterm labourPreterm labour
Preterm labour
 
Antepartum hemorrhage
Antepartum hemorrhageAntepartum hemorrhage
Antepartum hemorrhage
 
Inversion Of Uterus
Inversion Of UterusInversion Of Uterus
Inversion Of Uterus
 
Ante partum haemorrhage
Ante partum haemorrhageAnte partum haemorrhage
Ante partum haemorrhage
 
Eclampsia
EclampsiaEclampsia
Eclampsia
 
ectopic pregnancy
ectopic pregnancyectopic pregnancy
ectopic pregnancy
 
Multiple pregnancy
Multiple pregnancyMultiple pregnancy
Multiple pregnancy
 
management of placenta previa
management of placenta previamanagement of placenta previa
management of placenta previa
 

Destacado

Induction of labour (2)
Induction of labour (2)Induction of labour (2)
Induction of labour (2)drmcbansal
 
Clinical cases of normal labour - By Sara Khalid Memon
Clinical cases of normal labour - By Sara Khalid MemonClinical cases of normal labour - By Sara Khalid Memon
Clinical cases of normal labour - By Sara Khalid MemonSara Memon
 
An update INDUCTION OF LABOR : WHO, WHEN, HOW ,WHERE & OUTCOME DR. SHARDA J...
An update  INDUCTION OF LABOR : WHO, WHEN, HOW ,WHERE & OUTCOME DR. SHARDA J...An update  INDUCTION OF LABOR : WHO, WHEN, HOW ,WHERE & OUTCOME DR. SHARDA J...
An update INDUCTION OF LABOR : WHO, WHEN, HOW ,WHERE & OUTCOME DR. SHARDA J...Lifecare Centre
 
Inevitable abortion case presentation
Inevitable abortion  case presentationInevitable abortion  case presentation
Inevitable abortion case presentationDr.Shruthi Arun
 
Long case examination for phase iii medical students usmkk
Long case examination for phase iii medical students usmkkLong case examination for phase iii medical students usmkk
Long case examination for phase iii medical students usmkkAR Muhamad Na'im
 
Prostaglandins
ProstaglandinsProstaglandins
ProstaglandinsBS_90
 
Post term pregnancy
Post term pregnancyPost term pregnancy
Post term pregnancydrmcbansal
 

Destacado (9)

Induction of labour (2)
Induction of labour (2)Induction of labour (2)
Induction of labour (2)
 
Clinical cases of normal labour - By Sara Khalid Memon
Clinical cases of normal labour - By Sara Khalid MemonClinical cases of normal labour - By Sara Khalid Memon
Clinical cases of normal labour - By Sara Khalid Memon
 
An update INDUCTION OF LABOR : WHO, WHEN, HOW ,WHERE & OUTCOME DR. SHARDA J...
An update  INDUCTION OF LABOR : WHO, WHEN, HOW ,WHERE & OUTCOME DR. SHARDA J...An update  INDUCTION OF LABOR : WHO, WHEN, HOW ,WHERE & OUTCOME DR. SHARDA J...
An update INDUCTION OF LABOR : WHO, WHEN, HOW ,WHERE & OUTCOME DR. SHARDA J...
 
Inevitable abortion case presentation
Inevitable abortion  case presentationInevitable abortion  case presentation
Inevitable abortion case presentation
 
13 partogram
13 partogram13 partogram
13 partogram
 
case study
case study case study
case study
 
Long case examination for phase iii medical students usmkk
Long case examination for phase iii medical students usmkkLong case examination for phase iii medical students usmkk
Long case examination for phase iii medical students usmkk
 
Prostaglandins
ProstaglandinsProstaglandins
Prostaglandins
 
Post term pregnancy
Post term pregnancyPost term pregnancy
Post term pregnancy
 

Similar a induction of labor - A Clinical Case Discussion

Induction and augmentation of labour by dr jograjiya
Induction and augmentation of labour by dr jograjiyaInduction and augmentation of labour by dr jograjiya
Induction and augmentation of labour by dr jograjiyaJograjiya Gelabhai Raghubhai
 
Seminar induction of labour
Seminar   induction of labourSeminar   induction of labour
Seminar induction of laboureshna gupta
 
Induction of labor
Induction of laborInduction of labor
Induction of laborMansi Gupta
 
ABNORMAL MIDWIFERY 2-1.pptx
ABNORMAL MIDWIFERY 2-1.pptxABNORMAL MIDWIFERY 2-1.pptx
ABNORMAL MIDWIFERY 2-1.pptxKevinMaimba
 
Final first stage of labour
Final first stage of labourFinal first stage of labour
Final first stage of labourBalkeej Sidhu
 
Induction of Labour: SOGC, 2013 WHO, 2011 NICE, 2008
Induction of Labour: SOGC, 2013 WHO, 2011 NICE, 2008Induction of Labour: SOGC, 2013 WHO, 2011 NICE, 2008
Induction of Labour: SOGC, 2013 WHO, 2011 NICE, 2008Aboubakr Elnashar
 
induction of labour (4)(1).pptx
induction of labour (4)(1).pptxinduction of labour (4)(1).pptx
induction of labour (4)(1).pptxamanysaleh11
 
Abnormal Labor [ Natnael Dechasa Gemeda pdf ].pdf
Abnormal Labor [ Natnael Dechasa Gemeda pdf ].pdfAbnormal Labor [ Natnael Dechasa Gemeda pdf ].pdf
Abnormal Labor [ Natnael Dechasa Gemeda pdf ].pdfDire Dawa University
 
ABNORMAL.....Obstetrics and gynaecology.
ABNORMAL.....Obstetrics and gynaecology.ABNORMAL.....Obstetrics and gynaecology.
ABNORMAL.....Obstetrics and gynaecology.Lydiahkawira1
 
augmentation and IOL.pdf
augmentation and IOL.pdfaugmentation and IOL.pdf
augmentation and IOL.pdfnagamani42
 
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptxOBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptxmagie12
 
Operative obstetrics by Dr muhammad bilal
Operative obstetrics by Dr muhammad bilalOperative obstetrics by Dr muhammad bilal
Operative obstetrics by Dr muhammad bilalAyub Medical College
 
Augmentation of labour-Clinical Teaching
Augmentation of labour-Clinical Teaching Augmentation of labour-Clinical Teaching
Augmentation of labour-Clinical Teaching sonal patel
 
Management of normal labour Final yr.pptx
Management of normal labour Final yr.pptxManagement of normal labour Final yr.pptx
Management of normal labour Final yr.pptxIram Chaudhry
 

Similar a induction of labor - A Clinical Case Discussion (20)

Induction and augmentation of labour by dr jograjiya
Induction and augmentation of labour by dr jograjiyaInduction and augmentation of labour by dr jograjiya
Induction and augmentation of labour by dr jograjiya
 
Induction of lobour
Induction of lobourInduction of lobour
Induction of lobour
 
Seminar induction of labour
Seminar   induction of labourSeminar   induction of labour
Seminar induction of labour
 
Induction OF labor
Induction OF laborInduction OF labor
Induction OF labor
 
Induction of labor
Induction of laborInduction of labor
Induction of labor
 
ABNORMAL MIDWIFERY 2-1.pptx
ABNORMAL MIDWIFERY 2-1.pptxABNORMAL MIDWIFERY 2-1.pptx
ABNORMAL MIDWIFERY 2-1.pptx
 
Final first stage of labour
Final first stage of labourFinal first stage of labour
Final first stage of labour
 
Induction of Labour: SOGC, 2013 WHO, 2011 NICE, 2008
Induction of Labour: SOGC, 2013 WHO, 2011 NICE, 2008Induction of Labour: SOGC, 2013 WHO, 2011 NICE, 2008
Induction of Labour: SOGC, 2013 WHO, 2011 NICE, 2008
 
induction of labour (4)(1).pptx
induction of labour (4)(1).pptxinduction of labour (4)(1).pptx
induction of labour (4)(1).pptx
 
33644_First Stage of Labor.ppt
33644_First Stage of Labor.ppt33644_First Stage of Labor.ppt
33644_First Stage of Labor.ppt
 
Abnormal Labour.pptx
Abnormal Labour.pptxAbnormal Labour.pptx
Abnormal Labour.pptx
 
Abnormal Labor [ Natnael Dechasa Gemeda pdf ].pdf
Abnormal Labor [ Natnael Dechasa Gemeda pdf ].pdfAbnormal Labor [ Natnael Dechasa Gemeda pdf ].pdf
Abnormal Labor [ Natnael Dechasa Gemeda pdf ].pdf
 
ABNORMAL.....Obstetrics and gynaecology.
ABNORMAL.....Obstetrics and gynaecology.ABNORMAL.....Obstetrics and gynaecology.
ABNORMAL.....Obstetrics and gynaecology.
 
Normal Labour by Dr Salman
Normal Labour by Dr SalmanNormal Labour by Dr Salman
Normal Labour by Dr Salman
 
augmentation and IOL.pdf
augmentation and IOL.pdfaugmentation and IOL.pdf
augmentation and IOL.pdf
 
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptxOBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
OBSTETRICS AND GYNAECOLOGICAL NURSING- HIGH RISK PREGNANCY ABORTION.pptx
 
Operative obstetrics by Dr muhammad bilal
Operative obstetrics by Dr muhammad bilalOperative obstetrics by Dr muhammad bilal
Operative obstetrics by Dr muhammad bilal
 
Ectopic pregnancy
Ectopic pregnancyEctopic pregnancy
Ectopic pregnancy
 
Augmentation of labour-Clinical Teaching
Augmentation of labour-Clinical Teaching Augmentation of labour-Clinical Teaching
Augmentation of labour-Clinical Teaching
 
Management of normal labour Final yr.pptx
Management of normal labour Final yr.pptxManagement of normal labour Final yr.pptx
Management of normal labour Final yr.pptx
 

Más de Afiqi Fikri

Sepsis and rational use of abx
Sepsis and rational use of abxSepsis and rational use of abx
Sepsis and rational use of abxAfiqi Fikri
 
Post menopausal osteoporosis
Post menopausal osteoporosisPost menopausal osteoporosis
Post menopausal osteoporosisAfiqi Fikri
 
Common programme - 18 jan 17
Common programme - 18 jan 17Common programme - 18 jan 17
Common programme - 18 jan 17Afiqi Fikri
 
Common programme - 18 jan
Common programme - 18 janCommon programme - 18 jan
Common programme - 18 janAfiqi Fikri
 
Community medicine - Family planning
Community medicine - Family planningCommunity medicine - Family planning
Community medicine - Family planningAfiqi Fikri
 
Acute diarrhoeal disease (add)
Acute diarrhoeal disease (add)Acute diarrhoeal disease (add)
Acute diarrhoeal disease (add)Afiqi Fikri
 
Orthopaedics - Bone tumor (compiled cases)
Orthopaedics - Bone tumor (compiled cases)Orthopaedics - Bone tumor (compiled cases)
Orthopaedics - Bone tumor (compiled cases)Afiqi Fikri
 
Osteoarthritis - Case Based Discussion
Osteoarthritis -  Case Based DiscussionOsteoarthritis -  Case Based Discussion
Osteoarthritis - Case Based DiscussionAfiqi Fikri
 
Ewing's sarcoma - case scenario
Ewing's sarcoma  - case scenarioEwing's sarcoma  - case scenario
Ewing's sarcoma - case scenarioAfiqi Fikri
 
Osce - counselling on hormonal replacement therapy following TAHBSO
Osce  - counselling on hormonal replacement therapy following TAHBSOOsce  - counselling on hormonal replacement therapy following TAHBSO
Osce - counselling on hormonal replacement therapy following TAHBSOAfiqi Fikri
 
Hypertensive disorder in pregnanacy
Hypertensive disorder in pregnanacyHypertensive disorder in pregnanacy
Hypertensive disorder in pregnanacyAfiqi Fikri
 
Pelvic organ prolapse with sui
Pelvic organ prolapse with suiPelvic organ prolapse with sui
Pelvic organ prolapse with suiAfiqi Fikri
 
Osce - active management of 3rd stage of labor
Osce - active management of 3rd stage of laborOsce - active management of 3rd stage of labor
Osce - active management of 3rd stage of laborAfiqi Fikri
 
Case Discussion - Teen pregnancy
Case Discussion - Teen pregnancyCase Discussion - Teen pregnancy
Case Discussion - Teen pregnancyAfiqi Fikri
 

Más de Afiqi Fikri (14)

Sepsis and rational use of abx
Sepsis and rational use of abxSepsis and rational use of abx
Sepsis and rational use of abx
 
Post menopausal osteoporosis
Post menopausal osteoporosisPost menopausal osteoporosis
Post menopausal osteoporosis
 
Common programme - 18 jan 17
Common programme - 18 jan 17Common programme - 18 jan 17
Common programme - 18 jan 17
 
Common programme - 18 jan
Common programme - 18 janCommon programme - 18 jan
Common programme - 18 jan
 
Community medicine - Family planning
Community medicine - Family planningCommunity medicine - Family planning
Community medicine - Family planning
 
Acute diarrhoeal disease (add)
Acute diarrhoeal disease (add)Acute diarrhoeal disease (add)
Acute diarrhoeal disease (add)
 
Orthopaedics - Bone tumor (compiled cases)
Orthopaedics - Bone tumor (compiled cases)Orthopaedics - Bone tumor (compiled cases)
Orthopaedics - Bone tumor (compiled cases)
 
Osteoarthritis - Case Based Discussion
Osteoarthritis -  Case Based DiscussionOsteoarthritis -  Case Based Discussion
Osteoarthritis - Case Based Discussion
 
Ewing's sarcoma - case scenario
Ewing's sarcoma  - case scenarioEwing's sarcoma  - case scenario
Ewing's sarcoma - case scenario
 
Osce - counselling on hormonal replacement therapy following TAHBSO
Osce  - counselling on hormonal replacement therapy following TAHBSOOsce  - counselling on hormonal replacement therapy following TAHBSO
Osce - counselling on hormonal replacement therapy following TAHBSO
 
Hypertensive disorder in pregnanacy
Hypertensive disorder in pregnanacyHypertensive disorder in pregnanacy
Hypertensive disorder in pregnanacy
 
Pelvic organ prolapse with sui
Pelvic organ prolapse with suiPelvic organ prolapse with sui
Pelvic organ prolapse with sui
 
Osce - active management of 3rd stage of labor
Osce - active management of 3rd stage of laborOsce - active management of 3rd stage of labor
Osce - active management of 3rd stage of labor
 
Case Discussion - Teen pregnancy
Case Discussion - Teen pregnancyCase Discussion - Teen pregnancy
Case Discussion - Teen pregnancy
 

Último

SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 

Último (20)

Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 

induction of labor - A Clinical Case Discussion

  • 1. CASE A 24 year old Puan Nina was admitted to hospital on 8th August at 8.50 am for the induction of labour for post maturity, her pregnancy gestation is 40 weeks and 1 day. Previous Obstetric history: Gravid 3, Para 2, two previous normal deliveries. No history of any medical problems and no problems identified in this pregnancy. At 8.50am admitted to the Labour ward, no signs of labour on admission and the findings from the vaginal examination were that the cervix was 2 cm dilated. Decision was made to do an ARM (artificial rupture of membranes) and to commence Syntocinon.
  • 2. CASE The woman progressed well in labour and had a normal delivery of a female infant at 1.19pm, The infant's weight was 3.5kg, Apgar scores were 9 at 1 & 5 minutes.
  • 4. DEFINITIONS Induction of Labor (IOL) is defined as artificial initiation of uterine contractions before the spontaneous onset of labor. Augmentation of labor refers to stimulation of spontaneous contractions that are considered inadequate because of failed cervical dilation and fetal descent.
  • 5. INDICATION FOR INDUCTION 11 1. pre-eclampsia, eclampsia, chronic hypertension > 37wks 2. Diabetes, renal disease, chronic pulmonary disease 3. Premature rupture of membranes 4. Chorioamnionitis 5. Fetal growth restriction 6. Rh isoimmunization 7. Postdated pregnancy 8. Fetal demise 9. Abruptio placentae 10.Fetal malformations incompatible with life 11.Logistic factors: Risk of rapid labor, distance from hospital, psychosocial indications
  • 6. CONTRAINDICATION OF INDUCTION 11 1. Placenta praevia or Vasa praevia 2. Cord presentation 3. Abnormal fetal lie/ presentation 4. Cephalopelvic disproportion because of malpresentation or abnormal pelvic bone structure 5. Active genital Herpes infection 6. Invasive cervical carcinoma 7. Hypersensitivity to cervical ripening agents 8. Previous uterine rupture
  • 7. CONTRAINDICATION OF INDUCTION 11 1. Multiple pregnancy 2. Polyhydramnios 3. Grand multiparity 4. Maternal heart disease. 5. Severe hypertension. 6. Breech presentation 7. One or more previous cesarean section 8. Abnormal fetal heart rate not requiring emergency cesarean section CONDITIONS WHERE IOL IS NOT A TRUE CONTRAINDICATION BUT WHERE SPECIAL CAUTION IS REQUIRED :
  • 8. 1 RISK OF IOL MATERNAL RISKS I. Failure leading to Cesarean section II. Uterine hyperstimulation III. Rupture uterus IV. Intrauterine infection, Chorioamnionitis V. Amniotic Fluid Embolism VI. Precipitate labor , Dysfunctional labor VII.Increased risk of operative vaginal delivery VIII.Increased risk of post partum hemorrhage IX. Abruptio Placentae X. APH from undiagnosed placenta praevia XI. Water intoxication
  • 9. 1 RISK OF IOL FETAL RISKS I. Fetal distress . II. Fetal death III. Neonatal sepsis IV. Iatrogenic delivery of a preterm infant V. Cord prolapse VI. Neonatal jaundice VII.Increased risk of birth trauma
  • 10. PRE- REQUISITES FOR IOLI. Evaluate the indication II. Explain the indication to the patient + details of the method to be used and take a written informed consent III. Assess adequacy of the pelvis and fetal size IV. Confirm the gestational age, fetal lie, and assess the fetal lung maturity # where ever indicated V. Uterine activity and FHR should be continuously monitored. In case of clinical auscultation, FHR should be heard during and for 30 seconds after a contraction at least every 15 minutes during the active phase of labor and after every contraction in the second stage VI. Partogram is to be maintained for active labour VII.Trained personnel and well equipped center
  • 11. PRE INDUCTION CERVICAL ASSESSMENT: Modified Bishop’s Preinduction cervical scoring system: to determine the suitability of a patient for IOL in patients who were parous, at term , had an uncomplicated pregnancy and the fetus was in cephalic presentation. FACTOR 0 1 2 3 Dilatation (cm) 0 (closed) 1 – 2 3 – 4 5 Length (cm) >4 3 – 4 1 – 2 0 Position Posterior Midline Anterior - Consistency Firm Medium Soft - Head: station -3 -2 -1 , 0 +1 , +2 Score Total Score =13 Favourable Score= 6-13 Unfavourable Score= 0-5
  • 12. METHODS OF CERVICAL RIPENING AND IOL Methods for cervical ripening and labor induction can be broadly classified as : PHARMACEUTICAL MECANICAL SURGICAL
  • 13. METHODS OF CERVICAL RIPENING AND IOL MECHANICAL • Sweeping of membrane Membrane stripping at term shortens the interval of time to onset of spontaneous labor and reduces the need for formal induction. • Foley's catheter This uses the same mechanism as sweeping but the inflated bulb of Foley’s results in release of endogenous prostaglandins and initiates labor.
  • 14. METHODS OF CERVICAL RIPENING AND IOL • Exogenous Prostaglandins Prostaglandins (E2) are effective for both cervical ripening and- labor induction. Prostaglandin E2 are typically administered intravaginally for cervical ripening as the first step in labor induction. They are administered as gel, tablet or controlled release pessary. The recommended regimens are:  One cycle of vaginal PGE2 tablets one dose 3mg in a nulliparous and 0.5 mg in a multipara, followed by second dose after 6 hours if labor is not established . Maximum of 2 doses in a cycle.  One cycle of vaginal PGE2 controlled release pessary one dose over 24 hours. PHARMACEUTICAL
  • 15. METHODS OF CERVICAL RIPENING AND IOL intravaginal PGE2 are the preferred method of induction of labor, unless there are any specific indications for not using it like the risk of uterine hyperstimulation. Prostaglandins PGEl – Misoprostol Although studies have demonstrated that misoprostol is an effective agent in induction of labor, there are concerns regarding its safety and until the best dosage regimen is determined, its use in labor induction is confined to clinical trials. PHARMACEUTICAL
  • 17. METHODS OF CERVICAL RIPENING AND IOL  Oxytocin Increase in responsiveness with advancing gestational age. Once spontaneous labor begins the uterine sensitivity to endogenous oxytocin increases rapidly. The dose is typically increased until there is normal progress of labor or strong contractions occurring at 4 contractions per ten minutes and lasting for at least 45 seconds. There is no benefit to increasing the dose after one of these endpoints has been achieved. Continuous monitoring of uterine activity and fetal heart rate are important once oxytocin is in use . SURGICAL
  • 18. METHODS OF CERVICAL RIPENING AND IOL  Amniotomy It is an effective method of labor induction but can only be performed in patients with partially dilated and effaced cervices. The obstetrician should ensure that the fetal vertex is well-applied to the cervix and the umbilical cord or other fetal part is not the presenting part. The fetal heart rate before and after the procedure has to be documented and the color of the amniotic fluid should be noted. SURGICAL
  • 19. CERVICAL RIPENING & SUCCESSFUL INDUCTION  Oxytocin is less effective for labor induction when used in women with uneffaced and undilated cervices. Therefore, a ripening process should be used prior to oxytocin induction when the cervix is unfavorable.  The two major methods are as follow: I. Mechanical (physical) interventions, such as disruption of the fetal membranes or insertion of dilators or a balloon catheter. II. Application of cervical ripening agents, such as prostaglandin compounds.
  • 20. COMPLICATIONS  Hyperstimulation  Fetal hypoxemia  Hyponatremia  Hypotension  Hyponatremia  Failed induction  Uterine rupture  Hyperbilirunemia