Induction of Labour Guidelines

Introduction

• Induction of labour is the artificial start of uterine contractions to bring about birth before spontaneous labour.
• It's a common procedure, but risks and benefits should be carefully considered for both mother and baby.
• The All Wales guidelines provide a framework for safe and suitable induction practices.

Indications for Induction

• Post-term pregnancy (42 weeks or more): To reduce complications of prolonged pregnancy.
• Pre-eclampsia or gestational hypertension: To prevent worsening and related issues.
• Oligohydramnios: To reduce risk of fetal distress.
• Chorioamnionitis: To reduce infection risk.
• Diabetes Mellitus: To prevent complications from glucose control.
• Intrauterine growth restriction (IUGR): To improve fetal well-being if risk of distress is present.
• Fetal death: To deliver when fetal death is confirmed.
• Maternal medical conditions: Certain maternal conditions may indicate induction prior to spontaneous labour.
• Prelabour rupture of membranes (PROM) at term: Induction may be necessary if complications arise after PROM.

Contraindications

• Active genital herpes: To prevent transmission to the infant.
• Previous classical uterine incision or other significant uterine surgery: To prevent uterine rupture.
• Abnormal fetal presentation: Induction may not be suitable in these cases.
• Placenta praevia or vasa praevia: High risks mean induction should be avoided.
• Cephalopelvic disproportion (CPD): Induction poses risks with a fetal-pelvic mismatch.
• Recent vaginal bleeding: Requires careful assessment with other factors considered.
• Uterine scars or previous cesarean sections: Risk of uterine rupture needs careful consideration.
• Known maternal or fetal conditions posing induction risk: Individual assessment and consideration is essential.
• Fetal distress or other urgent delivery needs: Urgent circumstances are managed differently.

Methods of Induction

• Cervical ripening agents: Soften and dilate the cervix to initiate labour. Examples include prostaglandins and osmotic dilators.
• Oxytocin (syntocinon): Stimulates uterine contractions if the cervix is favorable. Requires careful administration and monitoring.

Monitoring during Induction

• Continuous fetal monitoring: Essential to determine fetal well-being throughout induction.
• Maternal vital signs: Regular monitoring is crucial to identify maternal complications.
• Assessment of contractions: Frequency, duration, and strength are monitored for appropriate intervention.
• Cervical assessment: Ongoing evaluation of cervical dilation and effacement guides the induction process.

Management of Failed Induction

• If induction is unsuccessful, a Cesarean section may be necessary for the safety of mother and baby.

Key Considerations in All Wales guidelines

• Individual assessment of risks and benefits: Specific circumstances of each woman are assessed for safe induction.
• Collaboration between all relevant professionals: Collaboration between obstetricians, midwives, and other healthcare professionals is needed.
• Clear communication between the clinicians: Clear communication is essential for a shared understanding and optimized approach.

Specific Protocols and Procedures

• Protocols vary by maternity unit/trust to maintain consistency.
• Guidelines are practical and support individualized care.