inducation of labour

1. Out line
INTRODUCTION
DEFINITION
INDICATION
BISHOPE SCORE
CONTRAINDICATIONS
METHODS OF INDICATIONS
COMPLICATIONS

2. INTRODUCTION
inducing labor is the stimulation of uterine contractions during pregnancy before
labor begins on its own to achieve a vaginal birth. A health care provider might
recommend labor induction for various reasons, primarily when there's concern for
a mother's health or a baby's health. Inducing labor can be accomplished with
pharmaceutical or non-pharmaceutical methods.
It is usually performed by administering oxytocin or prostaglandins to the pregnant
woman or by manually rupturing the amniotic membranes induction of labour is
most easily judged by assessing the progress of cervical ripening.

3. INTRODUCTION
This offers the best prognostic index of successful induction of labour. if the
Bishop score is high, reflecting a high degree of cervical ripeness induction of
labour usually can be achieved with very simple types of intervention. If, on
the other hand, the Bishop score is very low (regardless of the gestational age
of the pregnancy), it is much more difficult to bring about the conditions in
which labour will begin and consequently those efforts are much more likely
to fail.

4. Definition
A process whereby labour is
initiated by artificial means
after appropriate assessment
of the mother and fetus ,
(technique for stimulating
uterine contractions to accomplish delivery prior to the
onset of spontaneous labour )

5. INDICATION
1. Postterm pregnancy
WHO has recommended to induce labour after (40 weeks + 7 days )
After 42 weeks , placenta can no longer provide enough oxygen and nutrients for the
baby
2. Prelabor rupture of membranes is leakage of amniotic fluid before onset of
labor
Prelabor rupture of membranes (PROM) may occur at term (≥ 37 weeks) or earlier (called
preterm PROM if < 37 weeks).

6. INDICATION
3-COMPLICATIONS
Infection (biggest risk)
If the uterus becomes infected (chorioamnionitis), the baby must be delivered immediately.
• For preterm PROM, :the biggest risk is a preterm delivery, which increases risks of complications
for the baby. These complications include:
learning disabilities
neurological problems
respiratory distress syndrome
• Another serious complication is
umbilical cord compression. )Without amniotic fluid, the umbilical cord is vulnerable to damage(
Placental abruption)early detachment of placenta from uterus( , Postpartum infection

7. INDICATION
• Preterm PROM before the 24th week , it often results in death of the fetus because the
baby’s lungs are not able to develop properly. If the baby survives, they will often have long-
term problems, including:
chronic lung disease
developmental problems
hydrocephalus
cerebral palsy
.Nearterm,term or postterm :
ehT
tsigolocenyg will proceed to deliver thebaby. Labor might
occur by itself (spontaneously) or by inducinglabor using certain medications.

8. INDICATION
4-Chorioamnionitis: is a bacterial infection that
occurs before or during labor. infection that can occur
when bacteria that are normally present in the vagina
ascend into the uterus, where the fetus is located.
• E. coli, group B streptococci, and anaerobic bacteria are the most common causes of
chorioamnionitis.
• The amniotic fluid and placenta and baby can become infected.

9. INDICATION
5-Oligohydramnios
it is the condition that the uterus has not enough amniotic fluid
Causes:
1-PROM 2- problems with the placenta
3-birth defects
4-postterm pregnancy
5-medications
6-health conditions in mom

10. INDICATION
6-Placental abruption.
Your placenta peels away from the inner wall of the uterus before delivery — either
partially or completely.
7-Fetal growth restriction The estimated weight of your baby is less than the 10th
percentile for gestational age
1- Gestational diabetes 2-Hypertensive disorders 3-Certain medical conditions
HELLP syndrome :The HELLP syndrome is a serious
complication of pregnancy characterized by
haemolysis,elevated liver enzymes and low platelet count

11. Bishop score
 definition : also Bishop's score or cervix score, is a pre-labor scoring system to
assist in predicting whether induction of labor will be required.
_The Bishop score grades patients who would be most likely to achieve a
successful induction.
_ Used to determine the degree of cervical ripening
 Cervical ripening
_ is a normal process of softening and opening the cervix before labor starts.
_ often happens on its own, naturally

12. Bishop score
 Components
The total score is calculated by assessing the following five components on manual
vaginal examination by a trained professional:
• Cervical dilation in centimeters
• Cervical effacement
• Cervical consistency by provider assessment/judgement
• Cervical position
• Fetal station, the position of the fetal head in relation to the pelvic bones

13. Bishop score
Interpretation :
• A score less than 5 suggests that labour is unlikely to start without ripening of the cervix,
• A score of 7 indicates that labour has begun or is imminent.

14. Contraindication
induction of labor is stimulation of uterine contractions before spontaneous labor to
achieve vaginal delivery.
Induction of labor can be : Medically indicated (eg, for preeclampsia or fetal compromise)
,Elective (to control when delivery occurs) ,Before elective induction, gestational age must be
determined. Commonly, elective induction has been avoided at 39 weeks because of lack of evidence
for perinatal benefit and concern about a higher frequency of cesarean deliveries and other adverse
outcomes. This practice may be changing, partly because a 2018 study showed that induction of low-
risk women at 39 weeks reduced the frequency of cesarean deliveries (but not perinatal adverse
outcomes) compared with expectant management

15. Contraindication
Contraindications to induction include :
1. Fundal uterine surgery
2. Open maternal-fetal surgery (eg, myelomeningocele closure)
3. Myomectomy involving entry into the uterine cavity
4. Prior classical (vertical) cesarean incision in the thickened, muscular portion of the
uterus
5. Active genital herpes
6. Placenta previa or vasa previa
7. Abnormal fetal presentation (eg, transverse lie, umbilical cord presentation, certain
types of fetopelvic disproportion)
8. Multiple prior uterine scars and breech presentation are relative contraindications

16. METHODS OF Induction
Natural Ways to Induce Labor Exercise:
1-Sex 2- Nipple stimulation 3-Acupuncture 4-Acupressure
5- Castor oil 6-Spicy foods.
Exercise can be anything that gets the heart rate up, such as a long walk. Even if this method
doesn’t work, it’s a great way to relieve stress and keep your body strong for the task a head.
Sex :Theoretically, there are multiple reasons why having sex could induce labor
For example Sexual activity, especially having an orgasm, can release oxytocin, which may
help jumpstart uterine contractions.

17. METHODS OF Induction
Nipple stimulation: Stimulating your nipples can cause your uterus to contract and may bring about
labor. Nipple stimulations stimulate oxytocin production. Oxytocin is the hormone that causes the
uterus to contract and the breast to eject milk.
In fact, if you choose to breastfeed your baby right after delivery, this same stimulation is what will
help your uterus shrink back to its original size.
Acupuncture: Acupuncture has been used for thousands of years. The exact way that acupuncture
works is unclear. In Chinese Medicine, it’s believed that it balances the chi or vital energy within the
body. It might also stimulate changes in hormones or in the nervous system. Acupuncture should be
administered only by a licensed acupuncturist.

18. METHODS OF Induction
Acupressure :Some practitioners believe that acupressure can help start labor. If
acupressure doesn’t get your labor going, it can still be an excellent way to alleviate pain and
discomfort during labor.
Castor oil: Drinking a little bit, like only 1–2 ounces (29.57–59.14 mL) of castor oil stimulates
prostaglandin release, which can help ripen the cervix and get labor started. It’s
recommended that this be done under the supervision of a midwife or doctor. People should
be careful not to drink too much.

19. METHODS OF Induction
Eating dates: Some Trusted Source research shows that eating dates in the final weeks of
pregnancy increases cervical ripening and cervical dilation at the start of labor decreases the
need for Pitocin use during labor.
Medically Induced Labor : Many doctors will recommend induction if your pregnancy goes
beyond 41 or 42 weeks since your placenta becomes less efficient at nourishing your baby by
that time.2 Some doctors suggest inducing at 39 weeks since research shows that babies
born then have the healthiest outcomes.3 Before that, induction is only recommended when
your health or your baby's health is at risk due to infection, a medical condition like
preeclampsia, low amniotic fluid levels, or other problems.

20. METHODS OF Induction
Membrane Sweep: Membrane sweeping or stripping is when a doctor, midwife, or doula
gently separates the amniotic membrane from your cervix to stimulate the release of
prostaglandins, hormones that are essential for "ripening" (softening) the cervix in
preparation for delivery.“ ays.
Amniotomy: Most people go into labor within hours after their water breaks (when the
fluid-filled amniotic sac bursts).By artificially rupturing this sac

21. METHODS OF Induction
. Balloon Catheter : A balloon catheter, otherwise known as a Foley Bulb, is another option
to discuss with your medical team if your birth is being induced. In this procedure,a catheter
is placed and inflated with sterile water above the cervix, insidethe uterus. The balloon
mechanically dilates the cervix . Balloon catheter induction does not require the use of
medications, it can be used in conjunction with medications such as Cytotec (misoprostol).
Pitocin / Oxytocin IV Infusion: Administered at a hospital under close medical supervision,
pitocin and oxytocin infusions can be used to increase the rate and strength of contractions.

22. COMPLICATIONS
Inducing labor carries various risks, including:
• Failed induction: About 75 percent of first-time mothers who are
induced will have a successful vaginal delivery. This means that about 25 percent of these
women, who often start with an unripened cervix, might need a C-section. Your health
care provider will discuss with you the possibility of a need for a C-section.
• Low heart rate: The medications used to induce labor — oxytocin or a prostaglandin —
might cause abnormal or excessive contractions, which can diminish your baby's oxygen
supply and lower your baby's heart rate
• Infection: Some methods of labor induction, such as rupturing your membranes, might
increase the risk of infection for both mother and baby.

23. COMPLICATIONS
• Uterine rupture: This is a rare but serious complication in which your
uterus tears open along the scar line from a prior C-section or major
uterine surgery. An emergency C-section is needed to
life-threatening complications. Your uterus might need to be removed.
• Bleeding after delivery: Labor induction increases the risk that your uterine muscles
won't properly contract after you give birth (uterine atony), which can lead to serious
bleeding after delivery

24. NURSING CARE PLAN
The nursing care plan for a client in labor includes providing information regarding labor and
birth, providing comfort and pain relief measures, monitoring the client’s vital signs and
fetal heart rate, postpartum care, and preventing complications after birth. Here are
nursing care plans (NCP) and different stages of labor:
 First stage of labor
• This stage of labor is divided into three phases.
• The latent phase starts during the onset of true labor contractions until cervical dilatation.
• The active phase occurs when cervical dilatation is at 4 to 7 cm and contractions last from
40 to 60 seconds with 3 to 5 minutes interval.
• The transition phase occurs when contractions reach their peak with intervals of 2 to 3
minutes and dilatation of 8 to 10 cm.

25. NURSING CARE PLAN
Second stage of labor
• This stage starts at full cervical dilatation until the birth of the infant.
• The woman may experience an uncontrollable urge to push and bear down with every
contraction.
• Crowning or the appearance of the fetal head on the vaginal opening occurs.
Third stage of labor
• The third stage begins with the birth of the infant until the delivery of the placenta.
• The signs of placental expulsion are lengthening of the umbilical cord, sudden gush of
vaginal blood, changes in the shape of the uterus and its firm contraction, and the
appearance of the placenta at the vaginal opening.

26. NURSING CARE PLAN
Planning :-
• With all the data gathered during assessment and through an accurate diagnosis, a care
plan for the woman in labor would be made to aid her through her progress.
Care of a woman in the first stage of labor
• Labor should be allowed to start naturally, not artificially induced.
• The woman must also be allowed to move freely throughout the labor. Artificial
interventions should also be prohibited.
• Allow the woman to assume a non-supine position for delivery.
• Upon delivery of the newborn, mother and child should be given unlimited opportunity
for breastfeeding and bonding

27. NURSING CARE PLAN
Care of a woman in the second stage of labor
• During the second stage of labor, the place of delivery of the woman must be prepared.
• The position of birth wherein the woman is most comfortable must also be determined at
this stage.
• Another important part is the promotion of second stage effective pushing.
• Perineal cleaning is also an integral part of the second stage.
Care of the woman in the third stage of labor
• Placental delivery should be given focus at this stage. Once the placenta is
delivered, oxytocin should be administered intramuscularly to promote uterine
contractions.
• If there is episiotomy performed, perineal repair should be integrated into the care plan.

28. NURSING CARE PLAN
different stages of labor : Third Stage of Labor: Transition phase