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2|O B S T E T R I C S , 2 0 1 4
Trans by: Interior,F. & Garcia,J.A. edited by:Baluyot,Basalio,Ilano
Pregnancy Outcome Augmentation
- Malformation o Enhance spontaneous contractions of the
- Stillbirth patient
- Preterm birth Done because of insufficient
- Growth restriction uterine contractions for cervical
- Non reassuring fetal status dilation and fetal descend.
- Meconium aspiration syndrome
Indication for induction of labor:
Pulmonary Hypoplasia 1. Membrane rupture without labor
- Associated with oligohydramnios occurring 20-23 During very early pregnancy with leaking bag of
weeks AOG water:
- Chronic abruption sequence →placental hematoma o Expectant management done
→oligo: causes growth restriction and with poorer Bed rest
prognonis Antibiotics: prevent or avoid
- Expectant management – if baby is doing okay chorioamnionitis
continue pregnancy Watchful waiting
- Variable deceleration
During midpregnancy or late pregnancy
o Due to cord compression
o Induction of labor must be done to prevent
o Treatment- amnioinfusion
Management: development of infection
- Underlying etiology 2. Gestational hypertension
- Evaluation for fetal abnormality and growth o Causes uteroplacental insufficiency leading
- Preterm delivery for maternal complication to undesirable environment for the baby to
stay in the womb.
- Normal fetal anatomy and growth do expectant
3. Oligohydramnios
management and close surveillance
4. Nonreassuringfetal heart status
- AMNIOINFUSION- indicated only in Variable Fetal
5. Post term pregnancy
Heart Rate Deceleration due to cord compression.
6. Chronic hypertension
Significance
7. Diabetes mellitus
VFHRD: Cord Compression
o CAUTION: delay in pulmonary maturity
Early Deceleration: head compression
Contraindications for induction of Labor
Borderline Oligohydrmanios
MATERNAL CONTRAINDICATIONS:
- AFI 5-8 cm (BPS=2,with in Normal limit)
- Hindi siya oligohindi din poly 1. Uterine incision type
Types of uterine incisions:
Complication o CLASSICAL incision: vertical incision
- CS above the lower uterine segment, MOST
- Preterm delivery commonly associated with uterine rupture
- FGR o KERR incision: transverse incision in the
Management lower uterine segment, LEAST associated
- Insufficient evidence to support fetal testing or with uterine rupture
delivery o KRONIGS incision: longitudinal incision in
- Correlate clinically the lower uterine segment
2. Distorted maternal pelvic anatomy
INDUCTION OF LABOR 3. Abnormal placental implantation
o Ex: placenta previa
Stimulation of uterine contraction BEFORE
4. Maternal genital herpes
spontaneous onset of labor
o Must be ACTIVE GENITAL HERPES
o Example: walang uterine contraction,
o If (+) history of genital herpes with no
walang spontaneous onset of labor, may
active lesion during labor or delivery,
rupture of bag of water: angtawag pa din jan
induction CAN PROCEED
ay INDUCTION OF LABOR
5. Cervical cancer
o Increased risk for bleeding
Initial step in doing induction for close and uneffaced
*** sa exam daw tignanngmaigi kung anoangtinatanong.
cervix : CERVICAL RIPENING
Kung MATERNAL or FETAL contraindications
Kasi dapat munang palambutin ang
cervix para makapagdilate
o Use of PROSTAGLANDIN
3|O B S T E T R I C S , 2 0 1 4
Trans by: Interior,F. & Garcia,J.A. edited by:Baluyot,Basalio,Ilano
FETAL CONTRAINDICATIONS 2. Woman who lives in a long distance from the
1. Macrosomnia hospital
2. Severe hydrocephalus 3. Psychological manifestations
3. Malpresentation
4. Nonreassuring fetal status in abnormal fetal Factors affecting successful induction:
environment 1. Multiparity
2. BMI: <30
Before induction: 3. Favourable cervix: (Bishop’s score)
CST must be done to know if the baby can tolerate 4. Birth weight: <3500g
the stress of labor 5. Bishop score: equal or more than 9
6. Latent phase of 18 hours
Techniques for labor induction:
1. Oxytoxin Preinduction Cervical Ripening
2. Prostaglandin (Misoprostol/Dinoprostol) Use of prostaglandin E2 (dinoprostone), PGE1
3. Mechanical methods: (misoprostol)
o Membrane stripping Use of mechanical techniques
o Amniotomy o Transcervical catheter
o Cervical dilators o Extra-amniotic saline infusion
o Extra-amniotic saline infusion o Hygroscopic cervical dilators
Cervical Favorability
Maternal complications Bishop score: 9 = high likelihood of successful
1. Increase for cesarian section rate induction
o Risk is not affected by Bishop’s score Bishop score: less than 4 = unfavourable and may be
o 2-3x increased in nulliparas however they an indication of cervical ripening
are inversely related to bishop’s score
o If Bishop’s score is high = favorable cervix
= increased chance of vaginal delivery
o If Bishop’s score is low = increased cesarian
section rate
2. Risk for chorioamnionitis
3. Uterine rupture from prior uterine incision
o History of CS then nagvaginal delivery un
mother, risk for rupture is increased 3x
o But if with history of CS then oxytoxin was Pharmaceutical techniques
given, risk for rupture is increased 5x 1. Prostaglandin E2 – dinoprostone
o But if (+) history of CS + oxytoxin + Three forms: gel form, vaginal insert, suppository
prostaglandin = risk for rupture increased Expected time of delivery: within 24 hours, however
16x it does not decrease CS rate
o Recommendation: ACOG: Misoprostol ↑ risk of maternal complication
(prostaglandin) use is contraindicated for ↑ risk of uterine tachysytole
cervical ripening or labor induction among o Prepidil:
patient with prior uterine scar. Gel form
4. Postpartum hemorrhage from uterine atony When coupled with OXYTOXIN:
o Uterotonics can cause uterine muscle fatigue improves bishop score and lowered
o Because all receptors are already occupied induction-to-delivery
overwhelming the receptors thus saturating No benefit for lowering cesarian
the receptors delivery rate
5. Uterine Atony o Cervidil
o Associated with selective induction Vaginal insert
o ↑risk: 3x Combined with OXYTOXIN:
shortens induction-to-delivery
Elective Labor Induction interval
Not usually done because of increased risk for
maternal outcome
Accepted only with the following logistical reasons:
1. Risk of rapid labor
4|O B S T E T R I C S , 2 0 1 4
Trans by: Interior,F. & Garcia,J.A. edited by:Baluyot,Basalio,Ilano
Administration: 25mcg: recommend dose for cervical ripening for
vaginal dose
For postpartum haemorrhage: 4 whole
tablets rectally
Decreases the need for oxytoxin
induction and reduce induction-to-delivery
intervals
CAUTION: increased rate of uterine
hyperstimulation with fetal heart rate changes
50mg intravaginal dose: effects:
significant
increased uterine
tachysytole
meconium
passage
meconium
aspiration
Uterine rupture: risk for women with
prior cesarian delivery.
Elective Amniotomy
Indications:
Direct fetal heart rate monitoring
Accelerate labor: increased by 1-1 ½ hours specially
if amniotomy done with 5cm dilatation (active labor)
Complications:
Cord prolapsed-to avoid:make sure the head cannot
dislodge to cervix,hold the fundus.
Increased risk of developing chorioamnionitis
Membrane Stripping
Done to decrease the incidence of post term delivery
Advantage:
Does not cause uterine rupture,infection
Causes minimal bleeding
Safe
Disadvantage:
Discomfort
Minimal bleeding.
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6|O B S T E T R I C S , 2 0 1 4
Trans by: Interior,F. & Garcia,J.A. edited by:Baluyot,Basalio,Ilano