الفهرس 
Subject and methodsOnly 14 pages are availabe for public view
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Abstract
The management of labour ls basic to the practice of
obstetrtcs, Although most patients have a normal spontaneous
labour at term. On occaslon. The natural course of parturition
must be modified. Preventing or arreIJtlng Idiopathic preterm
labour may be required or conversely initiating and maintaining
labour may be needed.
Induction of labour represents one of tile two m.ost potent
weapons l’n the hands of the obstetrtclan In influencing the ,
course and success of pregnancy. the other being cesarean
section, These are the ob”stdTIclan’s methods of terminatlng
pregnancy at O! near term.
As the effectiveness and rellablllty of labour-inducing
methods increased. there was also a parallel increase In the
acce.ptablllty of the obstemclane to apply these methods.
Many factors are Involved In the control of the onset and
progress of human parturition offering. at: least theoretically. a
wide army of potentia] approaches to controtllng labour In ctlnlcai
practice.
0.t
It is almost true [hat the cioser the patient to the onset of
labour, the easier and more successful the Induction will
(Calder 198.3)
The best guide to this progress Is an assessment of the
state of the cervix using scoring system such as that described by
Bishop (1964).
In practical terms, patients WIth unripe cervix l.e, low
BIshop score, need more preparation before labour, l.e, the
method employee for ~nductlon should be capable of
reproduelng events of pre I~bor, This can be achieved by
employing a cervical ripening agent, before Induction of
1abour.(Noah, et aJ 19871”
Although the former Is never pertermed without Intentlon
of proceeding to the latter, It Is useful for clinical purpose to
distinguish between them. (:Noah et al 1987)
The clinical purpose of Ind.uction of labour has al!ways
been to Improve the outcome when It Is perceived that allowing
the pregnancy to continue In Its natural course would present
some jeopardy to the mother, her ba:l:JyOr to both.
It has alWl’\YS reaw”~ Intervention of this sort may
In Itself carry 118ks.and e:... sui rlskshave to be considered in
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an overall assessment In the management of the Individual case.
The risk ·of Induction should never be allowed to exceed the
dangers of allowing the pregnancy to continue.
Justiflcation ofinductioD (.•••eo to deliver):
The guiding prmctpte when consIdering labour Induction
should be to appi)’ t.oevery pregnancy (the obstetric
balance) (Calder 1983)”
For the great maJority of pregnancies. the balance will
remain securely tipped agablst intervention! The rLs~ of
Interruption will outweIgh those of non lnterventlon and these
conditions will.continue to prevaJ:1until the spontaneous onset of
labour at term results In the delivery of a healthy offspring.
In a mJnortty of pregnancies, however. the risks inherent in
oontlnulng the pregnancy may be perceived to rise to a point
where the ballance tips in favour ’of Intervention. Only then can
Inductlon be justifiably consIdered {Calder. 199 I)
Pactors affi:ditlgtbe course 01 induOf!d. labom
I. Uterinesensitivity
As pregnancy proceeds. the uterine muscles become more.
and more. !mtable and pregnant women fe~ more and more
weeks of pre;gnancy. At the
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same time, the sensitivIty of the uterine muscle to oxytocin Is
increased (Anderson, et al 1969), and this sensitlvlty to oxytocin
can also be related to the degree of ripeness of uie cervix.
2. CenlcaI ripenbtg:
During the last weeks prior to labour, the cervix undergoes
btochemicar as well as structusal chang~ that can be detected
dlnlcally(t1endrlcks, et a! 1970). TheBe are referred to as cervtcal
ripening and the degree of this ripen1l:lg at the Ilme of active
labour Is of a decisive Importance with regards Its course and
duralion. These changes are manifest as softening.. shortening
and dHataUon of the cervix.
Various scores, (Calder. 1983}have; been proposed for the
quantltative assessment of cervlcal rlpeness. I5lshop score Is the
most commonly used one In our country. This system ~ses a
scale (rom 0-13 to assess the station of the presenttnq fetal part,
and the cervical length, dilatation, consIstency and position in the
birth canal. Also the modlfled Bishop score Is another method of
assessmelll(Bishop, 1964).
3. Farity:
Primiparae have a longer duration of labour than
multiparae ill both the first and the second stages of labour.
Measured in Bishop score units the difference In duration of
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labour between prtrnt and nulliparae Is 3-4 points
(Bishop. 19M}.
It does not appear. however. to be mare difficult to Induce
labour in primiparae. provided of-oourse that the cervtx is ripe
(BishOP, 1964).
Un~ortunately, the cervix Is more often unripe than in
ml.l!llllparae.
4. other factoJ’sl
It ~ unclear whether the ase of the mother has any
influence on the course of labour .(Noah. et at 198?}
However, It Is recognized that the cervIcal condition In
elderly primiparae Is more often unnpe than In younger
primiparae. NeIther the size nor the gestatIonal age of the foetus
seems to have a direct Innuence on either the duration or
Induc:1btllty of labour .(Lange, 1982)
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