Labor induction : procedure and benefits


Labor induction

Artificial process of starting labour or stimulation of child delivery using medicines is called as Labor induction. Labour induction is done when labor is not started normally and the birth of baby has to be taken place in order to save life of both mother and baby.


Need for Labour induction

  • Post dated delivery more than two weeks, If labor is not induced the baby becomes large and it becomes a fatal condition.
  • When no uterine contractions started after rupture of membranes,
  • Maternal increased blood pressure or Eclampsia, or preeclampsia,
  • Infection of uterus and birth canal,
  • Pregnancy with Diabetes,
  • Less amniotic fluid around the baby.

In all these conditions labor induction is done by the doctor or obstetrician.

Procedure of Labor induction

Labor can be induced by different methods. Before induction of labor, the cervix is checked for softness or any dilation of cervix. If cervix is not open a medicine is placed in the cervix region. The medicine helps in softening and opening of cervix.

Rupture of amniotic sac is also done with the finger or with the help of amnihook and it also starts Labor. In some cases labor does not start even after the water comes out from the amniotic sac. The rupture of membranes may cause infection if proper hygienic methods are not taken.  Keen observation is done to take any measures to conduct delivery of the baby.

Oxytocin is the medicine given to induce the labor. Usually the medicine oxytocin is given through intravenous ( I V ) route. Strong and regular uterine contractions are started after the administration of Oxytocin.

When oxytocin fails to induce labor, the Caesarean section is done to take out the baby from the womb of mother.

Pitocin is given in some mothers to induce labor.

Postpartum hemorrhage: symptoms, causes, risk factors & treatment

PPH is abbreviated as postpartum hemorrhage. The bleeding occurring in the birth canal of mother within ten days after delivery, even with normal delivery or cesarean section is called as postpartum hemorrhage. If not treated Postpartum hemorrhage is a life threatening complication, leads to shock and even death of mother if proper medical care is not given. The blood loss in Postpartum hemorrhage is greater than 500 ml in normal delivery and more than 1,000 ml in cesarean section delivery.

Postpartum Hemorrhage Facts

  • Usually 1 to 10 % of pregnant mothers experience postpartum hemorrhage after delivery, according to american statistics.
  • Haemorrhage can occur before placental delivery or after placental delivery.
  • Postpartum hemorrhage leads to severe maternal morbidity and mortality.
  • 17% maternal mortality is due to Postpartum hemorrhage.
  • If bleeding is continuous, surgical intervention is needed to treat postpartum hemorrhage.
  •   Asian women have high incidence of postpartum hemorrhage.
  •   Postpartum hemorrhage occurs in women of child bearing age.


Postpartum Hemorrhage Causes

Uterine atony

 It is the main cause of postpartum hemorrhage. Uterine corpus is improperly constricted in case of uterine atony. Risk factors of uterine atony are

1) Overdistended uterus : Due to  multiple gestation, fetal macrosomia, hydramnios etc.
2) Fatigued uterus : Because of augmented or prolonged labor, amnionitis.
3) Obstructed uterus : caused due to  retained placenta or fetal parts, placenta accreta.

Uterus trauma

injury to uterus continuity, trauma of cervix, or birth canal, etc causes postpartum hemorrhage. Uterus trauma causes are:-

1) Delivery of a large infant ( baby with large head)
2) Instrumental delivery or intrauterine manipulation (using of  forceps, vacuum extraction of baby using ventous)
3) normal birth after cesarean section (VBAC)
4) Episiotomy

  • Blood coagulation disorders such as thrombocytopenia, may present before pregnancy or occur during labor
  • Uterine inversion, uterine rupture also causes  postpartum hemorrhage.
  • Drugs used to induce labor,
  • Prolonged labour,
  • Infection of birth canal at the time of labor,
  • Obesity of pregnant mother, etc are the causes postpartum hemorrhage.

Postpartum hemorrhage risk factors

  • Preeclampsia
  • Previous history of postpartum hemorrhage,
  • Asian or Hispanic ethnicity
  • Nulliparity or multiparity of pregnant mother.

Symptoms of Postpartum haemorrhage

  • Uncontrolled bleeding from birth canal,
  • Decrease in  blood pressure,
  • Increased heart beat rate,
  • Decreased  red blood cell count,
  • Swelling and pain in tissues of perineal area and birth canal,

Treatment of postpartum hemorrhage

Treatment of postpartum hemorrhage is given after the careful assessment by the physician or Obstetrician.

  • Nature of  pregnancy, health status of mother and medical history of pregnant mother,
  • Duration and extent of Hemorrhage,
  • Medications taken by the mother, procedures such as instrumental delivery, or any secific therapies.

The aim of treating  postpartum hemorrhage is to stop bleeding or hemorrhage as early as possible. Treatment for postpartum hemorrhage are

  • Examine uterus for any injury or to find uterus atony.
  • Medications to induce  uterine contraction.
  • Massage of Uterus manually, as it stimulates uterine contractions.
  • Pack the uterus with sterile sponges stop Hemorrhage.
  • Remove the part of placenta attached to uterus in case of incomplete placental delivery.
  • Ligation of bleeding blood vessels,

Laporatomy : Abdomen is opened and visualized for any uterus damage to find out the cause of postpartum hemorrhage.

Hysterectomy : is the term used for removal of uterus when all the remedial measures fail to stop postpartum hemorrhage.

Blood transfusion to restore the blood lost during hemorrhage.

Administer I V fluids, nearly 2000 to 2500 ml in the first day after delivery.

Treat Shock with administration of electrolytes and fluids.

Administer oxygen to mother  if  needed.

All the measures should be taken to restore the health of mother and to save the life of the mother.

Pregnancy signs : true and false pregnancy signs and child birth

Pregnancy signs

Number of signs indicate labor and gives the clue that the process of child birth has been started. Most of pregnant mothers  are confused that they have labor, is it true labor signs or not. Careful observation and assessment helps in finding signs of labor. pregnancy labor is the term used by some people for child birth process or labor. The differentiation between false labor and true labor signs is important.


The common signs of Pregnancy

Lightening

It is the process of changes takes place in the mothers womb. The fetal head reaches or enters the pelvis at the end stage of pregnancy. The mother feels some comfort and feels abdomen as lightened and is called as lightening. Mother feels easy breathing as the lungs get more space to expand. The pregnant Mother need to urinate more often as the pressure increases in the pelvic region.

Lightening in pregnant mother occurs several weeks prior to first delivery or child birth.

Bloody Show

Passage of mucus with blood is called as bloody show. It is pinkish or brown in colour and is identified by the mother in the bath room. The mucus present during pregnancy in the cervix comes out at the time of labor.

The bloody mucus indicates that cervical changes are occurring such as dilation of cervix,  thinning or moving forward to facilitate child birth or labor process. Sometimes the mucus is found after vaginal examination during end stage of third trimester of pregnancy.

Differentiation of true labor sign is important to initiate precautionary measures for safe child birth. So bloody show is the important sign of pregnancy labor.

Stomach upset is noticed in some mother along with abdominal cramps due to contraction.

Mucous plug

during pregnancy cervix is plugged with a thick mucous and protects the baby by blocking the lower end of uterus or entrance of the uterus. Soon after the cervical dilation the mucous plug is released.

During the release of mucus plug, the amount of bloody mucus increases and is the clear sign of labor. Mucus plug is also important sign of pregnancy labor.

Loose stools

passage of loose stool is  also the important sign of labor. Is the natural body mechanism in which rectum becomes empty after passing stools. This enhances the easy passage of baby through birth canal.

In most of institutions enema is given before the labor process starts in order to evacuate the bowel. Loose stools starts during true pregnancy labor and is the clear sign of labor.

Uterine Contractions

The major sign of labor is contraction of uterus. The rhythmic high intensity contractions helps in the delivery of baby. The uterine contraction stimulates dilation of uterus and makes passage for the fetus or baby. Pregnant mothers experiences contraction in the end of pregnancy. but not all contractions are labor contractions.

There is a difference between true labor contractions and other contractions. The labor contractions are rhythmic, occurs at regular interval, the intensity of contraction is high, and mother feels more pain during true labor uterine contractions. Uterine contractions are true labor signs. Braxton hicks contractions  are false uterine contractions increases during labor and indicates labor sign.

Pain in back and front of abdomen

Backache is associated with stronger uterine contractions, and lower abdominal pain, and it indicates the labor. Due to muscle contractions and pressure exerted by the moving fetus or baby in the birth canal causes backache with severe pain. are the important signs of labor.

Cesarean section: indications, care after delivery

  • esarean section is the procedure of delivery of baby through an incision made in the lower abdominal wall. A small incision is made as the baby can be taken out and after baby is born the walls are repaired using stitches. The baby birth after cesarean section is called as cesarean delivery.
  • Cesarean delivery is the surgical procedure used to expel the baby from the mother’s womb when normal birth canal delivery is not possible. Cesarean section is the surgical form of child birth.
  • Cesarean section recovery takes some weeks. Effective post operative care of mother helps in easy recovery after cesarean section. Care after cesarean section includes immediate care after cesarean section, and care given for a period of week.
  • Bleeding after cesarean is the common complication and nurse plays a major role in identifying bleeding after cesarean section.


Indications of cesarean delivery

Cesarean section is indicated when normal  delivery through birth canal might cause damage to the mother or baby. Reasons for cesarean delivery are as follows.

  • High risk pregnancy
  • presence of pelvic mass
  • prolonged labor
  • shoulder dystocia
  • apparent fetal distress
  • apparent maternal distress
  • pre eclampsia and hypertensive disorders,
  • pelvic contractions,
  • pelvic carcinoma,
  • cephalopelvic disproportions,
  • multiple pregnancy
  • malpresentation suc has breech presentation
  • failed induction  of labor
  • Macrosomia or large baby,
  • placenta previa, placenta abruptio,
  • umbilical cord abnormalities etc.
  • sexually transmitted diseases like genital herpes
  • history of previous cesarean section

care after cesarean delivery

  • Administration of intravenous fluid is important.
  • Inject methargin 2 mg IM route to stop bleeding.
  • Oxytocin drip may be administered to make the uterus to contract and stop bleeding
  • Monitor vital signs,
  • Administer sedatives such as Diazepam.

Vacuum pump extraction delivery: birth complications, indications & advantages

  • Vacuum extraction or ventouse is an instrumental device designed to  assist delivery by creating vacuum between it and fetal scalp. The pulling force created by the vacuum, pulls the baby and and drags the skull of the baby.
  • Vacuum delivery is the safest method of delivery or child birth.
  • The vacuum extractor or ventouse consists of suction cup with four sizes, 30, 40, 50 and 60 Cm.
  • A vacuum pump and traction rod device.


Indications of vacuum extraction
:-

  • deep transverse arrest with adequate pelvis,
  • delay in the descent of high head in case of second baby of twins,
  • alternative to forceps application,
  • as an adjunct to symphysiotomy.

Advantages of vacuum extraction are

  • vacuum extractor can be used with malroated occipito posterior position of the head.
  • Vacuum extractor can be applied even with incompletely dilated cervix,
  • Lesser taction force is needed in case of vacuum extractor.
  • Requires less technical skill for vacuum extraction.
  • Fetal complications with vacuum extraction are very less.
  • there should not be slightest bony resistance below the head.
  • cervix should be at least 6 cm dilated.
  • careful application of vacuum pump is needed for safe child birth.

Complications of vacuum extraction

  • superficial scalp abrasion,
  • sloughing of the scalp,
  • cephalohematoma,
  • intracranial hematoma,
  • retinal hemorrhage,
  • subaponeurotic hemorrhage

Ectopic pregnancy: causes, symptoms and treatment

Implantation of fertilized ovum other than the uterus tissue is called as ectopic pregnancy

tubal pregnancy is the main form of ectopic pregnancy. Implantation of ovum also occurs in the cervix and ovaries and also can occur in abdomen. great tissue damage occurs at the site of implantation other than the uterus and is very dangerous to health of mother.

Ectopic pregnancies are called as tubal pregnancies because more than 95% pregnancies occurs in the fallopian tube of the mother. tissues other than uterus do not have a nourishing tissue for growing fetus. Hence the implanted embryo bursts as it grows and causes damage to the implanted site.  An ectopic pregnancy does not develop into a complete pregnancy and child birth is not possible.

Causes of ectopic pregnancy

After fertilization the fertilized egg has to be  attached in wall of uterus. In case of ectopic pregnancy egg becomes unable to come down from the fallopian tube to uterus. Inflammation or an infection of fallopian tube  causes ectopic pregnancy.

  • pelvic inflammatory disease ( PID ),
  • Gonorrhea or chlamydial infection,
  • and other infections causes blocking of fallopian tube,
  • partial or complete blockage of fallopian tube,
  • Endometriosis,
  • previous cesarean section,
  • scar formed due to surgery of fallopian tube or abdomen,
  • congenital defects or abnormal growths in reproductive structures.

Symptoms of ectopic pregnancy

The initial symptoms of ectopic pregnancy are similar to normal pregnancy such as

  • missed period,
  • breast tenderness,
  • nausea, vomiting,
  • frequent urination, etc..

symptoms of Ectopic pregnancy are

  • pain in pelvic region,
  • Pain is sharp and stabbing,
  • Unilateral pain occurs as implantation occurs in single side of tube,
  • Rupture of the tube,
  • Internal bleeding at rupture of tissue site,
  • Low blood pressure,
  • lower back pain,
  • dizziness ans painting, etc
  • are the main symptoms of ectopic pregnancy.

Treatment of Ectopic pregnancy

Treatment of an ectopic pregnancy depends on the condition of  woman, size of fertilized egg, implantation of the pregnancy.

An early treatment of ectopic pregnancy includes injection of methotrexate, which disrupts the growth of the embryo and expels it out.

If the duration of pregnancy is long,  surgery to remove the abnormal pregnancy or ectopic is needed. Large incision was made in previous time to perform the surgery to remove ectopic pregnancy and it has become an easy procedure now because of modern technologies. Laparoscopy is the minimal invasive surgical procedure used to remove ectopic pregnancy or to treat ectopic pregnancy

The obstetrician or surgeon makes small incisions in the lower abdomen and then inserts a tiny video camera and instruments through these incisions. The image is caught from camera and is shown on a screen in the operating theater. This  helps the  surgeon to visualize inside of abdomen without making large incisions. The ectopic pregnancy is then surgically removed and other damaged organs are also repaired  if needed.

After surgery the HCG hormone level becomes  zero. HCG hormone level becomes normal after a week of surgery. An elevated HCG could mean that some ectopic tissue is present in the fallopian tube. This ectopic tissue may have to be removed using methotrexate or additional surgery.

High blood pressure pregnancy causes, symptoms and treatment

Hypertension pregnancy or pregnancy induced hypertension is the hypertension or increased arterial pressure developed during pregnancy. The changed hormonal levels in the body and physiological changes causes hypertension during pregnancy. The hypertension pregnancy or high blood pressure pregnancy develops after the gestational age of 20 weeks.

Symptoms of hypertension in pregnancy

Swelling over ankles, hands and puffiness of face are main symptoms of high blood pressure in pregnant mother. Mother may complaint headache as soon as she wake up from the bed. Dizziness is also present with some discomfort.

Causes of hypertension in pregnancy

Persistent elevated hypertension with systolic blood pressure of more than 160 mm of Hg and diastolic blood pressure of more than 110 mm of Hg in pregnant mother is called as pregnancy hypertension or pregnancy induced hypertension.

Hypertension in pregnancy occurs only in some women but not in all pregnant mothers. Mother develops high blood pressure because of increased blood volume during pregnancy. High blood pressure pregnancy is developed into pre eclampsia.

The untreated high blood pressure pregnancy becomes complicated with HELLP syndrome and Eclampsia. Eclampsia is the high blood pressure pregnancy with convulsions. Pre eclampsia and eclampsia affects the health of both mother and growing fetus. only 2 to 3 % of pregnancies becomes complicated with eclampsia.

Treatment of hypertension pregnancy

  • Immediate control of hypertension pregnancy is needed to protect the fetus and to promote  intrauterine fetal growth and development. Untreated high blood pressure pregnancy may become fatal and Labor or child birth becomes very difficult. Hypertension pregnancy is the cause of higher maternal, prenatal mortality and morbidity rate in India.
  • Close monitoring of mother with high blood pressure pregnancy is needed to prevent complication for both pregnant mother and baby. No specific treatment is needed if hypertension stays in mild elevated level.
  • Hospitalization is needed for health care and to avoid emergency at the time of child birth or labor.
  • Now a days stem cell therapy is used to treat pregnancy hypertension.
  • Anti hypertensives and anti convulsant are required to treat Eclampsia.

Uterine repture during pregnancy: causes, symptoms and treatment

Uterine rupture  is the obstetrical problem or complication of pregnancy. injury to the continuum of events at the weak point of the uterus. Uterine rupture is normally noticed by the obstetrician or doctor while conducting Cesarean section. The tearing of uterus normal continuity and bleeding occurs from the site of uterine rupture.

  • Uterine rupture usually occurs during early stage of labor.
  • abnormal fetal heart rate indicates uterine rupture.
  • uterine scar formed because of previous cesarean section increases the risk of uterine rupture.
  • Uterine rupture in some mothers develop at the end stage of pregnancy.
  • labor augmentation by use of oxytocin causes uterine rupture.
  • abdominal pain and bleeding are the common symptoms.
  • emergency care includes laparotomy and cesarean section
  • administration of fluids and blood transfusion.

Risk factors and causes of  uterine rupture

  • Women who have had previous surgery of  the uterus are at risk of uterine rupture.
  • Uterine rupture occurs usually on upper muscular portion of uterus.
  • Prior classical Cesarean sections, where the incision is done in upper uterus.
  • incision extended through the full thickness of the uterine while  removal of fibroid tumors of uterine wall,
  • Uterine surgery which affects full depth of the muscular portion of the uterus wall also causes uterine rupture.
  • Grand multi para, i.e. mother have given birth to more than four babies and become pregnant have risk of uterine rupture.
  • Distended uterus in case of multiple pregnancy causes uterine rupture.
  • Transverse position of baby,
  • Use of labor inducing medications such as picotin, prostaglandins, also increases the risk of uterine rupture.

Treatment of uterine rupture

  • Deliver the baby by means  emergency cesarean section. hysterectomy is done if the damage to mother’s uterus is severe and the bleeding is not controlled. Otherwise, pregnant mother’s uterus can be repaired. The mother need blood transfusion as she loses excess blood during bleeding. Administer IV antibiotics to prevent infection.
  • Recovery from the surgery takes more than a week.
  • Take complete bed rest
  • Follow up medical care and take medications properly.

Breech delivery: breech presentation causes, types and injuries

If the buttocks are delivered first it is called as breech delivery. only 3 to 4% pregnancies are with breech presentation at birth. Breech position is an abnormal position and vertex presentation is normal birth presentation.

Most breech birth or breech presentation occur at the 32 week of gestation and at this time head of fetus is not turned down.  The main causes of breech presentation or birth are

  • Prematurity is the main cause of breech presentation. Increased amniotic fluid or polyhydraminos,
  • Fetal abnormalities such as hydrocephaly, anencephaly, and congenital abnormalities of fetus,
  • Maternal abnormalities such as Uterine abnormalities.
  • Placental abnormalities, Uterine fibroid and
  • Multiple pregnancy.

Types of breech presentation are

  • Frank breech presentation : baby’s buttocks comes first, and breech baby’s legs are flexed at the hip and extended at the knees (with feet near the ears). Nearly 65 to 70% of breech  delivery are in the frank breech position.
  • Complete breech delivery: the baby’s hips and knees are flexed so that the baby is sitting cross legged, with feet beside the bottom. This is not common as frank breech position.
  • Footling breech delivery : one or both feet come first, with the bottom at a higher position. This is footling breech position is rare at term but relatively common with premature fetuses.
  • * Kneeling breech delivery :  The breech baby is in a kneeling position, with one or both legs of breech baby are extended at the hips and flexed at the knees. This Kneeling breech delivery position is not common type of breech delivery.

Common injuries to breech babies during breech delivery

Umbilical cord prolapse : Is the common abnormality of breech delivery. As soon as the amniotic sac ruptures, the umbilical cord expels out. Due to umbilical cord prolapse the breech babies  receives less oxygen and becomes oxygen deprived.

Head injury : Injury to fetal skull or brain occurs as the late coming head of baby struggles to come out of maternal pelvis. Cranial lacerations, and intracranial hemorrhage may occur. Squeezing of abdomen causes damage to internal organs of breech baby.

Severe hemorrhage is the main complication to mother. Breech birth or breech delivery is one of the causes of maternal mortality. Hysterectomy is indicated in some mothers when uterine rapture occurs. External cephalic version is done in some mothers before labor starts.

Even most of the experienced doctors have stopped conducting birth canal breech delivery and they will plan for cesarean section to prevent injury to new born baby and to avoid maternal complications. It is confirmed that elective cesarean section is done by concerning fetal and maternal well being.

Pregnancy weight gain tips for normal and obese mothers

A number of physiological and metabolic changes that occur during pregnancy are responsible for pregnancy weight gain. Gaining adequate weight during pregnancy by eating a healthy balanced diet is very essential for well development of growing fetus. The diet during pregnancy should provide all nutrients that mother needs. Pregnancy weight gain is related to height weight and body mass index of pregnant mother.

The pregnancy weight gain happens as the baby grows, mother consumes good nutrients to serve the baby. Generally pregnant mother have to consume extra 100 to 300 more calories in order to serve the growing fetus.

Health care provider will tell how much weight the pregnant mother should gain during pregnancy. Pregnancy weight gain in normal mothers is nearly 9 to 10 kg. Mothers who are weak before pregnancy should increase the pregnancy weight gain than normal pregnant women. The mother who is obese before pregnancy should increase pregnancy weight gain by 3 to 4 kg. The medical advice is needed to maintain correct pregnancy weight gain.

Pregnancy weight gain is distributed as follow

  • Baby                                       – 8 pounds
  • Placenta                                – 2 to 3 pounds
  • Amniotic fluid                    – 2 to 3 pounds
  • Breast tissue                       – 2 to 3 pounds
  • blood supply                       – 4 pounds
  • uterus growth                     – 2 to 5 pounds
  • Increased fat in body      – 5 to 9 pounds
  • Total                      – 25 to 35 pounds.

Tips for weight maintenance

  • Eat frequent but small diet with good nutrients.
  • eat easy snacks on hand, nuts, raisins, cheese, crackers, dried fruit, and ice cream etc.
  • Use pulses and grams in food as it provides adequate protein to the body.
  • Milk and milk products can be used adequately as they provide most of the vital nutrients to the body and help in maintaining weight gain.
  • Eat fiber rich diet to  avoid constipation
  • green leaf vegetables are very essential food for pregnant mother to have an ideal weight gain and to provide enriched nutrients to pregnant mother.

Increased pregnancy weight gain! what to do ?

If you have increased weight during pregnancy in the first trimester or early pregnancy stage, don’t try to reduce the weight by avoiding food. Back ache and drowsiness are the common problem with increased pregnancy weight gain.  Use food with less fat and calories and use much green leaf vegetables to avoid further weight gain during pregnancy. Consult your doctor and ask him what all you can eat and in what quantities.