Managing Complications in Pregnancy and Childbirth: - IAWG

P-24 Induction and augmentation of labourPROSTAGLANDINSProstaglandins are highly effective in ripening the cervix duringinduction of labour.• Check the woman’s pulse, blood pressure and contractions andcheck the fetal heart rate. Record findings on a partograph (page C-65).• Review for indications.• Prostaglandin E 2 (PGE 2 ) is available in several forms (3 mg pessaryor 2–3 mg gel). The prostaglandin is placed high in the posteriorfornix of the vagina and may be repeated after 6 hours if required.Monitor uterine contractions and fetal heart rate of all womenundergoing induction of labour with prostaglandins.• Discontinue use of prostaglandins and begin oxytocin infusion if:- membranes rupture;- cervical ripening has been achieved;- good labour has been established;- OR 12 hours have passed.MISOPROSTOL• Use misoprostol to ripen the cervix only in highly selectedsituations such as:- severe pre-eclampsia or eclampsia when the cervix isunfavourable and safe caesarean section is not immediatelyavailable or the baby is too premature to survive;- fetal death in-utero if the woman has not gone intospontaneous labour after 4 weeks and platelets are decreasing.• Place misoprostol 25 mcg in the posterior fornix of the vagina.Repeat after 6 hours, if required;• If there is no response after two doses of 25 mcg, increase to 50mcg every 6 hours;