1. Dr Ling Soon DiekO&G specialistSarawak General Hospital
2. DEFINITION Artificial initiation of labour (before the onset of spontaneous labour) With the aim of achieving delivery
3. INDICATIONS IOL is indicated when: The benefits of delivery to the mother or fetus outweigh those of continuing with the pregnancy When delivery will be of benefit to the health of the fetus or mother or both The risks of IOL should be weighed against the benefits of continuing with the pregnancy Risk Benefits
4. INDICATIONS Maternal problems Diabetes mellitus/GDM Hypertensive disorders Renal disease Abruptio placenta Anticipated compromise of fetal welfare with continuation of pregnancy IUGR Oligohydramnios Chorioamnionitis Previous IUD History of APH Twins IUD Prolonged pregnancy Others PPROM PROM
5. TIMING OF IOLIndications TimingPost dates 40 weeks + (7-10) daysPIH or HPT Not on treatment By 40 weeks On treatment +/-38 weeks (depends on severity)Diabetes/GDM Not on insulin Around 39 weeks On insulin 38 weeks (depends on severity)Indeterminate APH By 40 weeksEDD given by late scan >20w 38-40 weeks (Discuss with specialist)Unbooked, unsure of dates Discuss with specialistPPROM (persistent) >34 weeks (only in specialist hospital)PROM Immediate – 24 hours of leakingSocial induction To discuss with specialist
6. CRITERIA FOR IOL Dates are correct: Sure of LMP (regular cycle, was not on contraception) Early scan (<20 weeks) No acute fetal distress @ no factors that can increase risk of fetal distress in labour e.g severe IUGR Mother’s verbal consent
7. CONTRAINDICATIONS FOR IOL Any contraindication for normal vaginal delivery Suspected CPD 2 previous scars Cord presentation Malpresentation Placenta praevia Maternal HIV infection Active perineal herpes simplex
8. IN DISTRICT HOSPITAL No IOL for previous scar and grandmultipara All IOL must be discussed with specialist Maximum 2 prostin (3mg each) is allowed in a day Start induction in the morning Review 6 hours after 1st prostin, if no contraction, can insert 2nd prostin CTG before prostin CTG one hour after prostin If required > 2 prostin, to discuss with specialist
