Surgical Induction of Labour – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Surgical Induction of Labour
Procedure of surgical induction of labour:
Artificial Rupture of Membranes (Amniotomy):
It is an effective way to induce labour release of amniotic fluid shortens the muscle bundles of the myometrium the strength & duration of contractions are thereby increased and a more rapid contraction sequence follows.
Low rupture of membranes /forewater rupture:
b. It is done by using an aseptic technique and sometimes sedation even epidural anaesthesia may be needed to permit adequate examination.
c. Aseptically the index or middle finger is inserted through the cervical os. The membranes are stripped off the lower uterine segment and the bag of membranes are ruptured by a sharp pointed instrument. Liquor starts draining as the forewater rupture.
- Accidental haemorrahge.
- Severe pre-eclampsia & eclampsia.
- Post-dated pregnancy and post-term pregnancy.
- Placenta praevia type 1& 2 anterior.
- In coordinated uterine action especially hypotonic.
Induction of HRM:
- Chronic hydramnios (IfLRM is done sudden decompression may precipitate early separation of placenta & accidental Hge).
- Unstable lie after correction of the presentation.
Contra-indication of ARM:
- Intra-uterine foetal death.
- Malpresentation
Midwifery care before and after ARM:
Care before ARM:
1. Confirm the ARM indication, check for any contraindications to ARM, & the placental location.
2. Confirm the patient’s identification.
3. Explain the procedure to the woman, gain her consent, collect all the equipment & maintain privacy.
4. Encourage bladder emptying prior to the procedure.
5. Perform an abdominal palpation (fetal engagement/presentation) & auscultate the fetal heart.
6. Position the woman on an absorbent continence sheet in modified dorsal (with wedge) or lithotomy.
7. Perform hand hygiene & put on gloves, attend a vaginal examination (check cervical dilation/ progress, fetal presentation/station/position, & that no contraindications/cord/ vasa praevia present).
8. Identify the membranes, slide the amnihook down fingers and rotate against the membranes; or use an amnicot on the finger and turn upwards to break membranes.
Care after ARM:
9. Observe the amniotic fluid (colour, quantity, odour, consistency).
10. Assess the fetal heart rate.
11. Change wet bluey/ pads; Discard equipment and wash hands.
12. Document in medical records and Partogram, discuss findings with the woman. Notify any abnormalities.
Complications/danger of artificial rupture of membrane:
- Cord prolapse.
- It is irreversible. So once the procedure started no scope to retreat.man
- Uncontrolled escape of amniotic fluid.
- Injury to the cervix or the presenting part.
- Rupture of vasa previa leading to fetal blood loss.
- Accidental injury to placenta.
- Amnionitis.
- Intrauterine infection.
- Liquor amnii embolism.
Merits:
- An easy maneuver.
- Effective when combined with oxytocin infusion, 80% pts are in labour within 8 hours.
- It helps to control bleeding in APH.
- It helps to lower BP in severe PET & eclampsia.
- It helps to relieve maternal distress in hydramnios.
- It helps to relieve tension in abruptio placenta thereby minimizing utero -renal reflux leads to less chance of DIC & renal failure.
Demerits:
- The unripe cervix with a closed cervical os makes the procedure difficult.
- Risk of cord prolapse if the head is high or there is polyhydramnios.
- Risk of infection.
Medical induction is superior to surgical induction because:
- It is irreversible. So once the procedure started no scope to retreat.
- There is chance of cervical&/or intrauterine fetal injury.
- Effective uterine contraction can be achieved by regulating drug therapy in medical induction where there is a chance of failure to induce effective contractions in surgical induction.
- Chorio-amnionitis& intrauterine infection in surgicil induction but not in medical induction.
- Placental separation (abruption) & bleeding occurs in surgical induction.
- Maternal AIDS & genital active herpes infection can spread to fetus in case of surgical induction.
- Pulmonary embolism of amniotic fluid occurs in surgical induction.
Combined method is better:
ARM+Oxytocin
Or
PG+ARM
Because
1. It is more effective than any single procedure.
2. It shortens the induction delivery interval and thereby-
- Minimizes the risk of infection.
- Lessens the period of observation.
Medications to treat Labor Induction:
1. oxytocin
2. Cytotec
3. Pitocin
4. Syntocinon
5. Cervidil
6. misoprostol
7. misoprostol
8. dinoprostone
9. Prepidil
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