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What about anti-progestogens for inducing labour?
There is considerable interest in these chemicals. They are already in widespread use for second trimester termination of pregnancy. Mifepristone (RU486) is a case in point.
If the concerns about their safety can be conclusively allayed, they are bound to have a place in induction of labour.
Labour augmentation: Making labour efficient
Regarding labour augmentation, when does this become necessary?
If labour has commenced - i.e. the cervix has started to open and the uterus is contracting regularly but progress is unsatisfactory, labour augmentation is indicated.
When is labour progress deemed unsatisfactory?
Progress is judged by what is found to be happening to the cervix and the presenting part of the baby. Vaginal examination is the only way of verifying labour progress.
The cervix should dilate progressively and the minimum acceptable rate of dilatation is 1 cm per hour. The leading part of the baby should descend continually down the pelvic canal.
If serial examinations reveal that cervical dilatation is not taking place at the acceptable rate, it may be time to consider augmenting labour.
Head descent has been mentioned above; what if the leading part is a breech?
Most obstetricians contend that labour augmentation has no place in breech presentation.
Where vaginal breech delivery is practiced, poor labour progress in breech presentation is regarded as a warning sign of a possible difficult delivery and hence an indication for caesarean delivery. An experienced obstetrician will usually use his or her judgement on how best to proceed in each individual case.
The use of oxytocin infusion in breech presentation is certainly a contentious issue.
Does labour augmentation always succeed?
No. In some cases, in spite of prolonged use of an oxytocin drip at high concentrations, labour progress remains sluggish, even stagnant. The reason for this is not always clear. In any case, such a situation is an indication for caesarean delivery.
Is oxytocin infusion the only method available for labour augmentation?
Yes. Prostaglandins have no place in labour augmentation.
Using an infusion (drip) tends to restrict the labouring woman's movement. Can the oxytocin be administered as a one-off injection?
Unfortunately not. This drug has to be administered continuously and in well controlled (if necessary) incremental rates. A drip holder pole with castors for easy mobility will almost always be available if the woman wants to be ambulant and if this is deemed to be safe.
Last update: March 27, 2013