By ULY CLINIC

Stimulation of labour

Introduction

Myometrial stimulants should be used with great care before delivery especially in porous women. Use in obstructed labour should be avoided.

Oxytocics are indicated for:

The indication for induction must be documented, and discussion should include reason for induction, method of induction, and risks, including failure to achieve labour and possible increased risk of Caesarean section
If induction of labour is unsuccessful, the indication and method of induction should be re-evaluated.

Health care providers should assess the cervix (using the Bishop score) to determine the likelihood of success and to select the appropriate method of induction.
The Bishop score should be documented.
Care providers need to consider that induction of women with an unfavorable cervix is associated with a higher failure rate in nulliparous patients and a higher Caesarean section rate in nulliparous and parous patients.

Women should be offered induction of labour between 41+0 and 42+0 weeks as this intervention may reduce perinatal mortality and meconium aspiration syndrome without increasing the Caesarean section rate
Women who chose to delay induction >41+0 weeks should undergo twiceweekly assessment for fetal wellbeing

Intracervical Foley catheters are acceptable agents that are safe both in the setting of a vaginal birth after Caesarean section and in the outpatient setting
Double lumen catheters may be considered a second-line alternative

Misoprostol 25µg 8 hourly for 24 hours can be considered a safe and effective agent for labour induction with intact membranes and on an inpatient basis.

Note:

Misoprostol should not be used in the setting of vaginal birth after Caesarean section due to the increased risk of uterine rupture
Oxytocin should be started no earlier than 4 hours after the last dose of misoprostol

Amniotomy should be reserved for women with a favorable cervix. Particular care should be given in the case of unengaged presentation because there is a risk of cord prolapse.
After amniotomy, oxytocin should be commenced early in order to establish labour.
In the setting of ruptured membranes at term, oxytocin should be considered before expectant management.
Women positive for group B streptococcus (GBS) should be started on oxytocin as early as possible after ruptured membranes in order to establish labour within 24 hours.
Both high- and low-dose oxytocin may be considered within a hospital protocol.
Because of the various concentrations, oxytocin infusion rates should always be recorded in mU/min rather than mL/hr.
Oxytocin induction maybe considered in the hospital setting of vaginal birth after Caesarean section.
For induction of labour use: Oxytocin IV, the dose will depend on parity.

Oxytocin IV 5 IU in 500mls of fluid titrate at 15, 30, 60 drops per minute until desired uterine contractions are attained

Oxytocin IV starts with low dose e.g. 1.25 IU in 500mls of fluid titrate as above. Regulate the dose according to response.

Oxytocin (IV), initially 1U then 4U in 1 liter Normal Saline at 15, 30, 60 drops per minute until regular contractions lasting for more than 40 secondly are maintained. When 4U are not enough to cause maintained contractions, and it is first pregnancy, the dose can be increased to 16, 32 then 64U in liter of Normal Saline each time increasing the delivery rate through 15, 30 and 60 drops per minute.

If labour progress is not optimum labour augmentation is necessary. Can be achieved by:

Artificial rupture of membranes (ARM) and oxytocin. If membranes are already ruptured and no labour progress the steps above should be followed; rule out obstruction before augmenting labour with oxytocin.

Updated on, 3.11.2020

References

1. STG