1. INDUCTION OF
LABOUR
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2. Introduction
 Refers to the process of artificial initiation of
uterine contractions before their spontanuos
onset, leading to cervical dilatation and
effcacement and delivery of the baby.
 The term usually refers to procedures carried
out in the third trimester but occasionally to
gestations more than the legal definition of
fetal viability (24 weeks)
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3. Indications
 Generally, the purpose is to achieve benefit to
the health of the mother or baby or both
greater than if the pregnancy continues.
 Fetal
 Prolonged pregnancy (more than 41 weeks) ---
- commonest indication
 IUGR, DM, Polyhydramnios, Macrosomia,
Ruptured membranes, Multiple pregnancy,
Rhesus iso-immunization, IUGR,
oligohydramnios
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4.  Maternal
 Maternal disease e.g. renal disease,
hypertensive disorders, DM, Auto-immune
disease, Malignancy, IUFD
 Pregnancy related conditions e.g. PET,
recurrent APH
 Maternal request--Reasons must be justified
and the woman must be fully informed about
disadvantages
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5. Assessment before Induction
 Induction should only be performed in a setting
with facilities to monitor both mother and fetus
 Check dates again ---? Early scan
 Fetal lie and presentation
 Fetal viability
 VE to assess the condition of the cervix
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6. Methods of induction
 Traditional methods
 Castor oil, breast and nipple stimulation,
sexual intercourse
 Little evidence to support efficacy and may
sometimes be harmful
 Their use must be discouraged
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7. Medical Interventions
1- Mechanical
 Membrane sweeping
 Hygroscopic and mechanical dilators
 Extra-amniotic infusion of saline
 Amniotomy (ARM)
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8. 2- Biochemical
 Prostaglandin E2
 Prostaglandin E2 is agent of choice
 Long chain fatty acids derived from
arachidonic acid via the cyclo-oxygenase
pathway
 Given via the oral, intra vaginal, intra-cervical
or I.V routes
 Intra-vaginal gel and tablets have fewer side
effects
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9.  Misoprostol
 Prostaglandin E1 analogue
 Oxytocin
 An octapeptide hormone secreted from the
hypothalamus and stored in the pituitary
 Given via an infusion pump starting at a rate of
1-2mU/minute and doubling every 30 minutes
to a maximum of 32 mU/ml
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10. Choice of method
 Generally the more remote from term the more
difficult the induction
 Most important consideration is cervical
condition and ripeness
 Favorability of the cervix is assessed by
Bishops score (or one of its modifications)
 Score less than 5 is un-favorable
 The lower the score, the more likely induction
will fail and ripening with prostaglandins
should be carried out
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11. Complications of induction of
labour
 Failed induction
 Cord prolapse
 Abruption
 Hyponatremia
 Uterine hyperstimulation
 Post-partum hemorrhage
 Prematurity
 Hyperbillirubinemia and jaundice
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12. Special cases
 Induction following C/S
 Grandmutiparae
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