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Feb 20 2014

Induction of Labour

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  • 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