INDUCTION

AND
AUGMENTATION
OF
LABOUR
INTRODUCTION
 DEFINITION
medi
cal,

Initiation For the

of uterine surgi purpose of Induction
contractio cal vaginal of labour
delivery
ns

Com
bined
INDICATIONS
Hypertensive
disorders in
pregnancy

Maternal
Oligohydramnios,
medical
polyhydramnios
complication

Intra uterine
death of the Postmaturity
fetus

Fetus with
Abruptio
congenital
placenta
anomaly
 infection
of the
amniotic
sac.
Diabetes Fetal
in growth
pregnanc restriction
y .

Prolonged
Rhesus
premature
iso-
rupture of
immuniza
membran
tion
e

Twin
Unstable
pregnanc
lie
y
CONTRA INDICATION
Contracted pelvis

Mal presentation

Previous classical caesarean section

or hysterotomy

Uteroplacental factors: unexplained

vaginal bleeding
Active genital herpes infection

High risk pregnancy with fetal compromise

Heart disease

Pelvic tumour

Elderly primigravida with obstetric or medical

complication
RISKS
A
a r ean
caes on
secti

rupture
of the
uterus.
Foetal
distress
PARA METRES
Be sure about the indication of
induction of labour
Exclude the contraindication of
induction of labour

Ensure fetal well being

Ensure fetal gestation age and the

estimated weight

Assess the Bishop Score(Score>6

unfavourable)
MODIFIED BISHOP SCORE
SCORE 0 1 2 3

Dilation of 0 1or 2 3 0r 4 5 or more

cervix (cm)

Consistency of Firm Medium Soft -

cervix

Length of >2 2-1 1-0.5 <0.5

cervical canal
(cm)
Position of Posterior Central Anterior -
cervix

Station of -3 -2 -1 or 0 Below spines

presenting part

Total Score=13 Favourable score=6-13

unfavourable score=0-5
 NON
PHARMACOLOGICAL
PHARMACOLOGICAL
METHOD
METHOD
METHODS :
CERVICAL RIPENING
 Dinoprostone(PGE2)
Misoprostol(PGE1)
Dinoprostol(pG F2

PHARMACOLOGICAL METHOD
Dinoprostone (PGE2)
Misoprostol (PGE1)
Dinoprostol( pG F2

Prostaglan
Oxytocin
dins(PGS

Steriod
receptors
antagonist

Mifepristone
Onapristone
Relaxin
NON PHARMACOLOGICAL
METHOD
Stripping the membrane

Amniotomy

Mechanical dialators,Osmotic
dialators(laminaria), Ballon
catheter
MEDICAL INDUCTION OF LABOUR

Prostaglandin

– PGE2 and PGF2

– PGE1 (misoprostol)
Oxytocin
Points to be remembered
• Carefully observe women receiving oxytocin. 
• When oxytocin infusion results in a good
labour pattern, maintain the same rate until
delivery
• Be sure induction is indicated, as failed
induction is usually followed by caesarean
section. 
• Women receiving oxytocin should never be
left alone. 
• Do not use oxytocin 10 units in 500 mL (i.e.
20 mIU/mL) in multigravida and women
with previous caesarean section.
 
• Increase the rate of oxytocin infusion only to
the point where good labour is established
and then maintain infusion at that rate. 

• Increase the rate of oxytocin infusion only to

the point where good labour is established
and then maintain infusion at that rate. 
 
Mife pristine
SURGICAL INDUCTION
 
• Artificial rupture of the membranes:
• Amniotomy
• Stripping the membrane
• Mechanical dialators
 Artificial rupture of the
membranes:

Mode of action

• Release of prostaglandins.
• Bringing the presenting part closer to the
lower uterine segment so the uterine
activity will be reflexly encouraged.
Methods:
• Fore water (low) amniotomy:
Stripping of the membranes is done first,
then the forewater is ruptured by amnihook,
toothed forceps or Kocher's forceps.

• Hindwater (high) amniotomy:

The Drew-Smythe catheter is introduced
between the membranes and uterine wall to a
point above the presenting part.
STEPS

• Review for indications.

– Note: In areas of high HIV prevalence it is prudent
to leave the membranes intact for as long as
possible to reduce perinatal transmission of HIV.

• Listen to and note the fetal heart rate.

• Ask the woman to lie on her back with her

legs bent, feet together and knees apart.
• Wearing high-level disinfected gloves, use one hand to
examine the cervix and note the consistency, position,
effacement and dilatation.

• Use the other hand to insert an amniotic hook or a

Kocher clamp into the vagina.

• Guide the clamp or hook towards the membranes along

the fingers in the vagina.

• Place two fingers against the membranes and gently

rupture the membranes with the instrument in the other
hand. Allow the amniotic fluid to drain slowly around
the fingers.
• Note the colour of the fluid (clear, greenish,
bloody). If thick meconium is present, suspect f
etal distress.

• After ARM, listen to the fetal heart rate during

and after a contraction. If the fetal heart rate is
abnormal (less than 100 or more than 180 beats
per minute), suspect fetal distress.
• If delivery is not anticipated within 18 hours,
give prophylactic antibiotics in order to help re
duce Group B streptococcus infection in the ne
onate
:
• penicillin G 2 million units IV;/
• ampicillin 2 g IV, every 6 hours until delivery;
• If there are no signs of infection after delivery,
discontinue antibiotics.
• If good labour is not established 1 hour after
ARM, begin oxytocin infusion. 
• If labour is induced because of severe maternal
disease (e.g. sepsis or eclampsia), begin
oxytocin infusion at the same time as ARM.
 Disadvantages:

More incidence Separation of a

Less efficient in
of uterine posteriorly
inducing labour.
trauma. situated placenta.

Chance of
Higher incidence Liquor amnii
umbilical cord
of infection. embolism
prolapse
Procedure-(LRM)
• The patient is in lithotomy position
• Full surgical asepsis to be taken
• Two fingers are introduced into the vagina
smeared with antiseptic [Link] index
finger is passed through the cervical canal
beyond the internal os,The membranes are
swept free from the lower segment as far as
reached by the finger.
Amniotomy
Procedure-(LRM)
• With one finger still in the cervical canal with
the palmar surface upwards, along kocher’s
forceps with the blades closed or an amniohook
introduced along the palmar aspects of the
fingers upto the membranes.
• The blades are opened to seize the membranes
and are torn by twisting movements.
Amniohook is used to scratch over the
membranes.
Stripping the membrane 
• Stripping the membrane means digital
separation of the chorioamniotic
membranes.

• It is thought to work by release of

endogenous prostaglandins from the
membranes and deciduas. Manual
exploration of the cervix triggers Ferguson
reflex which promote oxytocin release from
maternal pituitary.
Mechanical dialators

• Dialators act by release of endogenous

prostaglandins from the maternal decidua to
induce labour and cervical ripening.
Hygroscopic dilators (laminaria) act by
absorption of water. They swell and forcibly
dilate the cervix.
THE COMBINED METHOD
 ACTIVE MANAGEMENT OF
LABOUR
components of active management of Labour
Prenatal Education

Women is admitted in the Labour room only after the

diagnosis of labour

One to one nursing care with partographic monitoring

of labour

Amniotomy with confirmation of labour

Oxytocin augumentation ifcervical dilation
is,1cm/hr

Delivery is completed within 12 hrs of

admission

Epidural analgesia if needed

Fetal monitoring by intermittent auscultation or

by continuous electronic monitoring

Active involvement of the consultant

obstetrician
Aim

• To expedite delivery within 12 hrs without

increasing maternal morbidity and perinatal
hazards.
 
Contraindications
• Presence of obstetric complication
• Presence of fetal compromise
• Multigravida(not routine)
Advantages
• Less chance of dysfunctional labour
• Shortens the duration of labour
• Fetal hypoxia can be detected in early
• Low incidence of caesarean birth
• Less analgesia
• Less maternal anxiety due to the support of
the care giver and prenatal education
LIMITATION

It is employed only in selected cases and in

selected centres where intensive intra
partum monitoring by trained personnel is
possible.
 AUGMENTATION OF
LABOUR
MEANING
• The word 'augment' means to 'increase or
enlarge'.
METHODS
MEDICAL METHODS –
 Mechanical
– Artificial rupture of the membranes
– Stripping the membrane
– Mechanical dialators
• Pharmacological
– Prostaglandin
– Oxytocin
– Mife pristine
• Combined method
DEFINITION

Augmenting the labour involves artificial

stimulation of the contractions. This may be
needed if the contractions have become
weak, not coordinated (or irregular), far
apart, not lasting long enough or have
ceased for a period. If the labour needs
augmenting, it means the contractions are
not efficient enough to dilate the cervix.
Research Article
Conclusion
THANK YOU !!!

HAVE A NICE DAY!!!