Managing Complications in Pregnancy and Childbirth: - IAWG

INDUCTION AND AUGMENTATION OF LABOUR P-17Induction of labour and augmentation of labour are performed fordifferent indications but the methods are the same.• Induction of labour: stimulating the uterus to begin labour.• Augmentation of labour: stimulating the uterus during labour toincrease the frequency, duration and strength of contractions.A good labour pattern is established when there are three contractionsin 10 minutes, each lasting more than 40 seconds.If the membranes are intact, it is recommended practice in bothinduction and augmentation of labour to first perform artificial ruptureof membranes (ARM). In some cases, this is all that is needed to inducelabour. Membrane rupture, whether spontaneous or artificial, often setsoff the following chain of events:- Amniotic fluid is expelled;- Uterine volume is decreased;- Prostaglandins are produced, stimulating labour;- Uterine contractions begin (if the woman is not in labour) orbecome stronger (if she is already in labour).ARTIFICIAL RUPTURE OF MEMBRANES• Review for indications.Note: In areas of high HIV prevalence it is prudent to leave themembranes intact for as long as possible to reduce perinataltransmission of HIV.• Listen to and note the fetal heart rate.• Ask the woman to lie on her back with her legs bent, feet togetherand knees apart.• Wearing high-level disinfected gloves, use one hand to examinethe cervix and note the consistency, position, effacement anddilatation.• Use the other hand to insert an amniotic hook or a Kocher clampinto the vagina.• Guide the clamp or hook towards the membranes along the fingersin the vagina.