Labor Induction 

What is labor induction?
It is when labor is started artificially by stimulating contractions.

It is decided when the risk associated with continuing the pregnancy is greater than the risk associated with induction.

Indications:

• Pregnancy overdue.
• Maternal medical diseases such as high blood pressure or diabetes.
• Rupture of membranes.
• Preeclampsia.
• Stillbirth.
• Fetus is not growing.
• Amniotic infection.
• Deficiency of amniotic fluid.
• Placenta abruption.

Contraindications:

• Previous uterine rupture.
• Previous surgeries in uterus.
• Previous C section.
• Placenta previa.
• Active genital herpes.
• Transverse fetus.
• Umbilical cord prolapse.
• Triplets pregnancy.

Pre induction evaluation:
Mother and fetus are both assessed:

• Gestational age estimation.
• Fetal position, weight and heart rate.
• Performing a cervical examination.

Labor induction methods:

For induction, the woman will be admitted to the hospital. CTG will be performed to assess fetal heart rate.

The cervical ripening (preparing the cervix for labor by being softer and shorter) is related to the success of vaginal delivery.

To achieve the ripening of the cervix, we use:

1. Vaginal Prostaglandin:

It can be tablets, gel or pessary.

You might need more than one dose after the first dose was given. And after 6 hours, you will be assessed if you need another dose (In case of gel or tablet).

For the pessary, one does is for 24 hours. So the procedure might take from hours to days before labor begins.

2.  Amniotomy:

When the membranes are ruptured . And it is used after the cervix is ripened (partially dilated and thinned).
After that, usually an infusion of Oxytocin is used as needed.

Labor induction complications:
– Failure of induction (15% to 25%).
– Bleeding after delivery.
– If the contractions last for too long or are too frequent.
– Uterine hyperstimulation: 1% to 5%, that might lead to oxygen deficiency and abnormal fetal heart rate.
– Rare possibility of uterine rupture.
– Possibility of cord prolapse when membrane rupture is performed for induction.
– Rare chance of the Amniotic fluid entering the mother’s bloodstream.