27 / 124
Methods of
Induction
Labor can be induced in
several ways, dependent
upon the cervix and if it is
favorable or ripe (a slightly
open cervix), or unfavorable
or unripe (a closed long
cervix). Prof. Abd Salman
notes that the doctor may
not tell the patient about
some risks listed and it may
seem worrying or disturbing,
however drug information
should be given about its use
and effects. “It is not intended
to frighten anyone, but to
help make the patient to
make a balanced, informed
decision based on the risks or
benefits,” she says.
Final Words
Essentially, Prof.
Abd Salman tells
that in spite of the
benefits and major
clinical indication
of induction labor,
it is still associated
with a large impact
on health of women
and their babies
so the process
needs to be clearly
justified before
starting.
Also there is a higher risk of
maternal and neonatal infection
with more preterm deliveries, she
points out. “The main neonatal
impacts on the baby include; a
higher rate of neonatal infection,
hyperbilirubinemia, with premature
delivery due to wrong date, with a
higher rate of admission in neonatal
intensive baby care unit (NICU),”
she says.
The Methods:
Sweeping membrane /
stretch and sweep
If the patient have a favorable
cervix this may be offered first as a
“drug –free” induction with fewer
side effects and risks compared
with other methods. It’s not usually
painful but may be uncomfortable
and result in some bleeding
afterward. Sweeping the membranes
involves a vaginal examination.
Artificial Rupture of
Membrane (ARM)
If the cervix is favorable and the
baby is in the pelvis, this choice
may be given for an induction. The
waters are broken in the hope this
leads to labor, however, it may give
a short time for contractions to
be established sometimes only an
hour or two – before being put on
an intravenous Oxytocin drip. “It is
important that the baby is in good
position before the membranes are
ruptured – if the baby is too high,
there is a risk of cord prolapse,
where the baby’s umbilical cord slips
through the cervix before the baby,
putting pressure on the cord,” says
Prof. Abd Salman. “This can be a
very serious situation as the baby’s
blood and oxygen supply becomes
compressed.”
If the labor is not progressing after
the membrane rupture, this is
probably going to have a Syntocinon
drip put up.
Artificial Oxytocinon
(Pitocin, Syntocinon)
Syntocinon is administered through
an intravenous drip with oxytocin
titration method and Prof. Abd
Salman explains that this may be
used if waters have broken but
there are no contractions or if
contractions don’t start on their
own. “When the patient will use
this drug, she must be monitored
continually as the doctors need to
know what effect this is having on
the baby,” she explains.
Prostaglandins
If the cervix is not ripe or
favourable, Prof. Abd Salman says
then prostaglandins are likely to
be used to soften and open the
cervix. “Should this be effective
and the cervix becomes at least
slightly open, the waters can then
be broken,” she says, however
prostaglandin may need several
doses to work, so the patient may
be asked to come in for extra
doses.
Prostin Gel
Prostin Gel is placed in the
vagina near the cervix during a
vaginal examination. “It works by
softening and dilating the neck
of the womb and stimulating
contractions,” indicates Prof.
Abd Salman. A second vaginal
examination is performed to check
the cervix.
H
25
May/June 2015