الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 179 |  |  |
| | | from | 179 | | |
Abstract
Induction of labour at term is a common obstetric intervention. Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of delivery of the feto-placental unit using mechanical or pharmacological methods. The goal of labour induction is to stimulate uterine contractions before spontaneous onset of labour, resulting in vaginal delivery.
Examples of some common conditions where induction is often indicated include, but are not limited to:
Post-term pregnancy,
Prelabor (premature) rupture of membranes
Preeclampsia
Fetal demise
Maternal diabetes
Fetal growth restriction
Chorioamnionitis
Abruptio placentae
Cholestasis of pregnancy
Alloimmunization with fetal anemia
CONTRAINDICATIONS
Prior uterine rupture
Prior classical or other high risk cesarean incision
Prior transmural uterine incision entering the uterine cavity
Active genital herpes infection
Placenta previa or vasa previa
Umbilical cord prolapse or persistent funic presentation
Transverse fetal lie
Invasive cervical cancer
Category III fetal heart rate tracing
COMPLICATIONS
Tachysystole
Rupture uterus
Amniotic fluid embolism
The ACOG recommends misoprostol as an efficient agent for cervical ripening and induction of labor at a dosage of 25 μg, administered intravaginally.However practitioners and researchers all over the globe have been interested to investigate its usage via other routes such as oral and other dosages which is considered off the label usage mostly between 25 and 50 μg dosages; on the other hand the active ingredient, instability is an issue that is still unresolved.
Misoprostol has advantages of being easy to use, convenient administration by various routes like the vaginal, sublingual and oral, being stable at room temperature, having a longer shelf life, and being relatively inexpensive.
Overall, misoprostol may be the best prostaglandin for labour induction, as titrated low-dose oral solution seems to be the safest in terms of caesarean section risk, while vaginal misoprostol tablets are the most effective in achieving vaginal delivery within 24 h of induction.
If elective induction is performed, there is expert consensus that it should not be performed before 39 weeks of gestation. Optimal candidates are women with favorable cervices (eg, Bishop score ≥8) and well-dated pregnancies ≥39 weeks, as these women are not at increased risk of long labor and iatrogenic prematurity.
PREDICTING A SUCCESSFUL INDUCTION
Cervical status
Cervical status immediately before oxytocin administration is a key factor for predicting the likelihood of successful induction and the Bishop score appears to be the best available tool for assessing cervical status.
Modified Bishop score — The modified Bishop score is the cervical assessment system most commonly used in clinical practice . This system tabulates a score based upon the station of the presenting part and four characteristics of the cervix: dilatation, effacement, consistency, and position (table 1). Cervical scoring systems other than the Bishop score exist, but are rarely used for predicting labor outcome..
Table (15): Modified Bishop scoring system