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Induction and Augmentation of Labor

Induction and augmentation of labor

1. indication for induction
1) common indication
¨ç ROM without spontaneous labor
¨è maternal hypertension
¨é nonassuring fetal status
¨ê postterm gestation
2) valid indication
¨ç ROM with chorioamnionitis
¨è severe eclampsia

2. contraindication for induction
1) uterine contraindication
¨ç prior disruption (classical incision, ut. surgery)
¨è placenta previa
2) fetal contraindication
¨ç macrosomina
¨è some fetal anomaly (hydrocephalus, malpresentation, nonreassurring fetal status)
3) maternal contraindication
¨ç maternal size
¨è pelvic anatomy
¨é selective medical conditions (active genital herpes, cervical cancer)

3. complication
- chorioamnionitis
- cesarean delivery (esp. unripe cervix)

4. cervical ripening
1) histological change : a dissolution of collagen bundles & an increase in submucosal water content
2) labor induction ½Ã cervixÀÇ »óŰ¡ ¸Å¿ì Áß¿äÇÏ´Ù. ƯÈ÷ cervix¿Í lower uterine segmentÀÇ ¹°¸®Àû ¼º»óÀÌ °¡Àå Áß¿äÇѵ¥, ÀÌ·¯ÇÑ ¹°¸®Àû ¼º»óÀ» ÅëÇÏ¿©, cervical ripening Á¤µµ¸¦ ÆÄ¾ÇÇϰí, labor inductionÀÇ ¼º°ø·üÀ» ¿¹ÃøÇÒ ¼ö ÀÖ°Ô Á¤¸®µÈ Á¡¼ö ü°è°¡ Bishop score ÀÌ´Ù.
3) Bishop scoring system used for assessment of inducibility
* ¡Â4 Bishop score : unfavorable cervix·Î¼­ PG cervical ripeningÀÇ indicationÀÌ µÈ´Ù.

4) preinduction cervical ripening
¨ç pharmacological techniques
a. PGE2
- cervical gel : dinoprostone gel
- vaginal inserts : cervidil
b. PGE1
- vaginal inserts : misoprostol
- oral administration: oral misoprostol
¨è mechanical techniques
a. EASI (extra-amniotic saline infusion)
- cervix¿¡ catheter°¡ ¿¬°áµÈ 30mL-balloonÀ» insertionÇÑ ÈÄ, catheter¸¦ ÅëÇÏ¿© normal salineÀ» õõÈ÷ ÁÖÀÔ½ÃŰ¸é¼­ balloonÀ» inflation ½ÃŲ´Ù.
b. hygroscopic cervical dilators
- laminaria : ¹Ù´Ù¿¡¼­ ³ª´Â ½Ä¹° Á¾À¸·Î¼­, ¿ø±âµÕÇüÀÇ ÀÛÀº ¸·´ë Á¶°¢Ã³·³ »ý±ä °ÍÀÌ´Ù. ¹°À» Èí¼öÇÏ´Â ¼ºÁúÀÌ ÀÖ¾î, ¹°À» ¸Ó±ÝÀ¸¸é ºÎÇ®¾î ¿À¸£°Ô µÈ´Ù.
c. membrane stripping
- °ËÁö ¼Õ°¡¶ôÀ» °¡´ÉÇϸé internal os±îÁö ¹Ð¾î ³õÀº ´ÙÀ½ 360µµ·Î µÎ ¹ø ȸÀü½Ã۸é, lower uterine segment¿Í membraneÀÌ ºÐ¸®µÈ´Ù.
¨é side effect of pharmacologic technique
a. uterine hyperstimulation : ÃÑ 20ºÐ°£, 10ºÐ¿¡ 6ȸ ÀÌ»óÀÇ ÀڱüöÃà
b. systemic effects : fever, vomiting, diarrhea°¡ ÀÖÀ¸³ª ¹«½ÃÇÒ ¸¸ ÇÏ´Ù.
c. glaucoma, severe hepatic or renal impairment, asthma ÀÖ´Â ÀӽźεéÀº º¹¿ëÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁ´Ù.

5. labor induction and augmentation with oxytocin
1) ¿ë¾î Á¤¸®
¨ç labor induction : stimulation of contractions before the spontaneous onset of labor, with or without ruptured membranes
¨è labor augmentation : stimulation of spontaneous contractions that are considered inadequate because of failure of progressive dilatation and descent
2) induction method
¨ç oxytocin : ÀϹÝÀûÀ¸·Î °¡Àå ¸¹ÀÌ ¾²ÀÌ´Â ¾àÁ¦
¨è amniotomy : artificial ROMÀ̶ó°íµµ ÇÔ