Induction of labor involves initiating uterine contractions through medical, surgical, or combined methods to facilitate vaginal delivery after the fetus reaches viability. Common reasons for induction include preeclampsia, post-term pregnancy, premature rupture of membranes, and non-reassuring fetal status. It is important to confirm the indication for induction and rule out any contraindications. The document then discusses various methods for induction, including medical induction using prostaglandins or mifepristone, surgical induction through artificial rupture of membranes or membrane stripping, and combined methods. Risks of induction include iatrogenic prematurity and increased cesarean rates if induction fails. Proper patient counseling and assessment of cervical ripeness are important factors for

2. Induction of labor means initiation of
uterine contractions (after the period of
viability) by any method (medical,
surgical, or combine) for the purpose of
vaginal delivery.

3.  - When the risks of continuation of
pregnancy either to the mother or to
fetus is more, induction is
indicated.(rarely preterm indication
may have to done).
 - Elective induction of labor.
 - The major risks are iatrogenic
prematurity ,increases cesarean
delivery for failed induction.

4.  - Pre-eclampsia, eclampsia.
 - Postmaturity.
 - Abruptio placenta
 - Premature rupture of membrane.
 -Intrauterine death of fetus.
 - oligohydramnios, polyhydnios.

5.  -Malpresentation (breech,transvere or
oblique lie).
 - High risk pregnancy with fetal
compromise.
 - Heart disease.
 -Umblical cord prolapse.
 -Cervical carcinoma.

6.  Postmaturity
 Intrauterine fetal death
 Pre-eclampsia/eclampsia
 Premature rupture of membrane
 Chronic hydraminous

7. MATERNAL :
. To confirm the indication for IOL
. Exclude the contraindication of IOL
. Adequate counselling about the
risks,benefits of IOL.
. Assess Bishopscore (score >6
favorable)

8.  FETAL:
 To ensure fetal gestational age
 To estimate fetal weight
 Ensure fetal presentation and lie
 Confirm fetal well-being

9.  Period of gestation - pregnancy nearer
the term or post term.
 Preinduction score - Bishop score >6
is favorable.
 Sensitivity of the uterus - Positive
oxytocin sensitivity test.
 Case profile - A low bishop < 5 is
unripe and unfavorable cervix.
 Cervical ripening -

10.  Induction of labor have three method
 1.Medical Method.
 2.Surgical Method
 3.Combinef Method.

11.  DRUGS USED : Prostaglandins PGE2,
PGE3.
: Oxytocin
: Mifepristone

12.  Act locally (autocrine and paracrine
harmones) on the contagious cells.
 PGE2 and PGF2 both cause myometrial
contraction But PGE2 is primarily
important for cervical ripening
whereas PGF2 for myometrial
contraction.
 Misoprostol (PGE1) is being used
either transvaginally or orally for
IOl.total 6-8 dose are used.

13.  It is an endogenous uterotonic that
stimulate uterine contraction.
 Oxytocin receptor contraction increas
during pregnancy and labor.
 Oxytocin acts by a) receptor
medication b) voltage mediated
calcium channel c)prostaglandian
presentation.

14.  Mifepristone (progesterone receptor
antagonists) block both progestrone
and glucocorticoid receptors.
 200 mg vaginally daily for 2 days to
induce labor.
 Onapristone is a more selective
progestrone receptors antagonists.

15.  METHODS :
It has three methods-
1.Aritificial rupture of membranes
(ARM)
2. Stripping the membrens
3. Low rupture of membrane (LRM)

16.  Mechanism of onset of labor : may be related
with (a) stretching of thee cervix (b) sepration of
membranes and ( c) reduction of amniotic fluid
volume.
 Effective depends on : (a) state of the cervix (b)
station of the presenting part.
 Advantages of amnioromy : (a) High success rate

17.  b) chance to observe the amniotic
fluid for blood or meconium. (c)
access to use fetal scalp.
 Limitation : it can not be employ in an
unfavorable cervix.(the cervix should
be at least one finger dilated)

18.  Lowering of the blood pressure in
pre-eclampsia,eclampsia.
 Relief of maternal distress in
hydramnios.
 Control of bleeding in APH.
 Relief of tension in abruptio placentae
and initiation of labor.

19.  Once the procedure is adopted ,there
is no scope of retreating from the
decision of delivery.
 Chance of umblical cord prolapse.
 Accidental injury to the placenta
cervix or uterus .
 Liquor amnii embolism.

20.  It is widely practised with high degree
of success..The branes below the
presenting part overlying internal are
rupture to drain some amount of
amniotic fluid.
 Contraindiction ; it iis preferably
avoided in chronic hydramnios, as
there risk of sudden massive liquor
drainage.

21.  Preliminaries - it is an indoor
procedure.The procedure may be
conducted in the labor ward or in
operation theatre.
ACTUAL STEPS =
 The patient is asked to empty her
bladder.
 Full surgical asepsis is to be taken.
 Two fingers are introduced into the
vagina smeared with antiseptic ointment.

22.  The index finger is passed through the
cervical canal beyond the internal.
 With one or two fingers still in the cervical
canal with the palmar surface upward, a
long Kochrr's forcep with the blades .
 The blades are open to size the
membranes and are torn twisting
movements.
 Amnihook is used to scratch over the
membranes.This is followed by viskible
escape of amniotic fluid.

23.  (a) color of the amniotic fluid.
 (b) statis of the cervix.
 (c) Station of the head.
 (d) Detection of cord prolapse.
 HAZARDS : a) cord prolapse
 (b) uncontrolled escape of amniotic
fluid
 c) Injury to the cervix.

24.  Stripping of the membranes means
digital sepration of the chrioamniotic
membranes from the wall of the cervix
and lowrr uterine segment.
 It is the simple safe and beneficial for
induction of labor.

25.  Act by release of endogenous
prostaglandians from the mmbranes and
maternal decidua to induce lablor and
cervical ripening.
 Hygroscppic dilatpr e.g. Laminaria
,lamicel act by absorption of water.they
swell and forcibly dilate the cervix.
 Mechnical dilators are as safe and
effective as PGE2 in cervical ripening.

26.  The combined medical and surgical
methods are commonly used to
increase the efficacy of induction by
reducing the induction -delivery
interval.
 The oxytocin infusion is started either
prior to or following rupture of the
membranes depending mainly upon
the state of the cervix.

27.  1) more effective than any single
procedure.
 (2 shortnes the induction delivery
interval.
 3) minimise the risk of infection.
 (4 lessens the period of observation.

28.  Prostaglandin (PGE2) - Used either in
the form of the gel 500 ug
intracervical or 1 to 2 mg in posterior
fornix.
 The application may have to be
repeated after 6 to 8 hours.
 Labor will start in 30 to 50 percent of
caese.

29. 2 - Stripping of the membranes : It is
possible if one finger can be introduced
through the cervix.
3 - Oxytocin infusion may be used with
some success.
However on occasion ,labor starts
following the use of any of method.

30.  Is a series of complex biochemical
changes in the cervix which is
mediated by the harmone.
 The cervix is normally two centimeters
long,firm and closed throughout
pregnancy.
 Umtimately the cervix becomes soft
and palpable.

31. THANQ