labor%20induction
LABOR INDUCTION
Labor induction is when an external agent is employed to stimulate contractions before the onset of spontaneous labor.
Labor augmentation uses the same techniques as labor induction but uterine contractions (frequency, duration and strength) are enhanced once labor has started.
Labor induction is generally indicated when the benefits of delivery outweigh the risks of continuing the pregnancy.
Women at 42 weeks of gestation who chose not to undergo labor induction should be monitored more often with at least twice-weekly assessment of fetal well-being (cardiotocography & estimation of maximum amniotic pool depth by ultrasound).

Monitoring

  • It is recommended that facilities for continuous uterine and fetal heart rate (HR) monitoring are available during labor induction
    • Continuous uterine activity and fetal HR monitoring is recommended if Prostaglandin E2 (PGE2) or Oxytocin is to be administered
    • Maternal pulse, blood pressure (BP), uterine contractions and fetal heart tone should be assessed and documented
  • Reassess Bishop score (after 6 hours for vaginal tablet or gel for 24 hours for controlled-release pessary)
  • Uterine tachysystole
    • Monitor for uterine tachysystole and institute appropriate management if it occurs
    • Patients should never be left unattended while Oxytocin is being administered
  • Appropriate measures if uterine tachysystole occurs
    • Discontinue Oxytocin or remove any remaining Prostaglandin preparation (do not irrigate cervix/vagina) and apply supportive/resuscitative measures if:
      • Uterine contractions exceed 5 in a 10-minute period (tachysystole) or
      • Uterine contractions last longer than 90-120 seconds
      • Fetal HR decelerates significantly; non-reassuring fetal heart rate tracing
    • For persistence of excessive uterine activity, begin tocolysis with
      • Terbutaline 250 mcg subcutaneous/intravenous (SC/IV) or
      • Glyceryl trinitrate 50-200 mcg IV or 1-2 sublingual spray (400-800 mcg) is recommended
      • Place patient in the lateral position, oxygen (O2) by face mask may be administered
    • Oxytocin may be restarted at 1/2 the dose if resuscitation is successful
  • Pain relief during induction of labor
    • Patients should be informed of the possibility of induced labor being more painful than spontaneous labor
    • Pain relief should be offered depending on what is appropriate for the patient and her pain
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Vincent YT Cheung, 01 Dec 2015

Ultrasonography has been widely used as a routine component of antenatal care. During the assessment of the foetus and the placenta, an adnexal mass may be discovered at the time of the ultrasound examination. Occasionally, an adnexal mass can also be suspected either on physical examination or as a result of clinical symptoms.
Roshini Claire Anthony, 06 Apr 2018

A better quality of diet during pregnancy is associated with lower neonatal adiposity and longer infant length at birth, according to findings from the GUSTO* study.

07 Apr 2018
Female cyclists do not have significantly worse urinary or sexual function compared with other athletes, a recent study has shown. However, other genitourinary conditions, such as saddle sores and genital numbness, are associated with cycling and may lead to sexual dysfunction.
26 Feb 2017
Placement of cervical pessary in women with short cervices and singleton pregnancies does not lower the risk of having preterm births, according to the results of a meta-analysis.