Abstract
Overall the rate of induced labours has increased and almost 25% of women undergo labour induction worldwide. Cervical ripening and cervical preparedness is necessary before labour can be induced. The status of the cervix is traditionally assessed with help of Bishop’s score. Labour induction becomes necessary when the cervix is not favourable as noted on the cervical scoring system. Mechanical or surgical methods or a combination of both can be sued for labour induction. These include Foley’s catheter induction, sweeping of membranes, amniotomy etc. Pharmacological agents like oxytocin, prostaglandins PGE1 & PGE2 and newer agents like mifepristone can be used. Mechanical methods like Foley’s catheter induction are associated with lesser FHR variability and decreased rates of caesarean section as compared with oxytocin infusion or prostaglandins used locally. Oxytocin is the most widely used pharmacological method used for induction of labour. Proper titration of oxytocin can result in contractions that mimic normal labour. Oxytocin is often combined with amniotomy. Prostaglandins PGE1 & PGE2 are safe and effective options for labour induction. Prostaglandin PGE1 or misoprostol is used in the dose of 25 microgram mcg given orally or vaginally or via the sub-lingual route. Prostaglandin PGE2 or dinoprostone is used intra-cervically or vaginally in the posterior fornix. The newer drug mifepristone is being studied as cervical ripening agents because of its anti-progesterone effect.
Highlights
Almost 25 % of all gravid women undergo labour induction and the overall rate of induced labor has almost doubled in the last decade [1]
The medications used for ripening of the cervix are oxytocin, prostaglandins PGE1 & PGE2, and newer agents like mifepristone
Mechanical methods are associated with a lesser fetal heart variability & decreased caesarean section rates as compared to oxytocin infusion or prostaglandins [13,14,15]
Summary
Almost 25 % of all gravid women undergo labour induction and the overall rate of induced labor has almost doubled in the last decade [1]. The purpose of induction of labour IOL is to artificially stimulate the uterus to start contractions before onset of spontaneous labor pains. Labor induction should be undertaken when it is clear that delivery will be beneficial for the mother and baby as compared to continuation of pregnancy [2]. It should be used with caution in cases of previous caesarean section and multigravidas. Methods, mechanical and surgical methods are currently being used widely and have proven to be helpful ripening of the cervix. The medications used for ripening of the cervix are oxytocin, prostaglandins PGE1 & PGE2, and newer agents like mifepristone. Oxytocin was discovered by Vigneaud et al [11]
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