Induction of Labour

1. Dr Ling Soon Diek
O&G specialist
Sarawak 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 IOL
Indications Timing
Post dates 40 weeks + (7-10) days
PIH 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 weeks
EDD given by late scan >20w 38-40 weeks (Discuss with specialist)
Unbooked, unsure of dates Discuss with specialist
PPROM (persistent) >34 weeks (only in specialist hospital)
PROM Immediate - 24 hours of leaking
Social 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