The more favourable the cervix the greater the likelihood of efficient labour induction, irrespective of the method chosen. Artificial rupture of the membranes (amniotomy) using a toothed forceps or purpose-designed plastic hook, is a simple method of labour induction. Depending on the urgency of the labour induction, oxytocin infusion may be started with the amniotomy or may be used only if progress after amniotomy is inadequate. Because of the considerable variability in sensitivity of the myometrium to oxytocin, oxytocin is administered as a variable dose infusion, titrated against uterine contractions. A typical dosage schedule would be 1 mU/min, doubling the rate of infusion every 20-30 min until adequate uterine contractions are achieved or a rate of 32 mU/min is reached. Once labour is established the infusion rate may be progressively reduced, as the myometrial sensitivity increases, to a rate of about 7 mU/min. Amniotomy should be avoided if the woman is not known to be free of infections such as HIV and hepatitis, in which case oxytocin infusion may be used with intact membranes.
Because amniotomy and/or oxytocin infusion tend to be ineffective when the cervix is unfavourable, it is customary to use amniotomy and/or oxytocin infusion for labour induction with favourable cervix and prostaglandins when the cervix is unfavourable. However, prostaglandins may equally be used when the cervix is favourable and in fact several trials (with rather small numbers) have shown various prostaglandins, including misoprostol, to be more efficient than oxytocin infusion for labour induction with favourable cervix and associated with greater satisfaction in the women.
Was this article helpful?
The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.