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Use of misoprostol for induction of labour mpdrs.pptx

  1. Use of misoprostol for induction of labour Essential maternal & Newborn clinical guideline 2022 Dr. Sam Ononge Senior lecturer (MakCHS) Obstetrician & Gynaecologist Member of AOGU, ECSAOGS, NASMEC- SLT/PPH sub-committee
  2. What is induction of labour • Artificial stimulation of uterine contractions before spontaneous onset of labour with the purpose of accomplishing successful vaginal delivery
  3. When to we perform Induction (Indications) Preeclampsia, PROM Post-term pregnancy (>41 wks) Abruptio placenta Medical conditions-DM, Heart dx, HPT etc IUFD Foetal malformations 4/1/2022 3
  4. When should not induce labour (contra) Contracted pelvis Major degree placenta praevia Transverse lie Previous CS scar H/O Myomectomy Hypersensitivity to inducing agent eg misoprostol When you do not have all CEmONC functions (*Blood & functional theatre) 23/03/2023 4
  5. Pre-requisite for induction of labour • Establish clear indication • Confirm the gestational age • Do CBC • Estimate fetal size & presentation • Pelvic assessment • Cervical assessment (BISHOPs score) • Availability of trained personnel (Dr, anaesthesia and • No contraindication to vaginal delivery • Book blood • Get Informed consent
  6. Methods of induction • Mechanical methods • Membrane stripping • Artificial rupture of membrane • Balloon catheters • Drugs • Oxytocin • Misoprostol • Dinoprostone gel
  7. Misoprostol for Induction of labour Available as a 200 microg tablet Low cost Stable at room temperature Easily administered: Orally or Vaginally for induction MOA Enables ripening of cervix A relaxation of cervical smooth muscle facilitates dilatation. Increase in intracellular calcium levels, causing contraction of myometrial muscle.
  8. Misoprostol for induction of labour Orally 25mcg (in solution) every 2 hours, maximum 8 doses or when labor is established Oral solution of misoprostol How to make the oral solution:  Dissolve 200mcg (1 tablet) of misoprostol in 200mls of drinking water. Give 25mls of the solution every 2 hours
  9. Misoprostol for induction of labour: Monitoring and documentation • Foetal well being • Foetal heart rate (120-160) • Liqour when membranes have ruptured • Maternal well being • Copying well or distressed • Vital signs: BP, Pulse & Temp • Progress of induction (labour) • Contractions ; frequency and duration • Descent of PP • Cervical dilatation
  10. Complications of induction using misoprostol Failed induction Uterine hyperstimulation (contraction lasting 60 secs or 4 contractions in 10 mins) Fetal distress Meconium aspiration Foetal death Rupture uterus Increased CS delivery PPH
  11. Conclusion • Never induce labour when you are not a functional CEmONC facility • Use recommended dose as per the guidelines • Monitor the induction process and document
  12. Thank you