A Study of Induction of Labour with Intracervical PGE2 Gel

INTRODUCTION: Labour refers to the onset of effective uterine contractions leading to progressive effacement and dilatation of the cervix resulting in expulsion of the fetus, placenta and the membranes. Watchful expectancy had been the dictum from times immemorial, with regard to parturition. Patient waiting for spontaneous onset of labour was the rule and any intervention advocated, only if expectant management jeopardized either maternal health or when continuation of pregnancy endangered life and wellbeing of mother or the fetus. Although most patients experience spontaneous labour at term, induction of labour is the option of modern day obstetrics when indicated. Labour induction is a clinical intervention that has the potential to confer major benefits to the mother and newborn when continuation of pregnancy poses a risk or danger to the outcome of pregnancy. Thus induction of labour has become a common obstetric practice referring to the process of labour where the uterine contractions are initiated by medical and surgical means before the onset of spontaneous labour. AIMS AND OBJECTIVES: 1. To study the various indications for induction of labour at term. 2. To study the impact of induction of labour with intracervical PGE2 gel and its complications and mode of outcome seen as successful vaginal delivery, instrumental delivery or operative delivery. 3. To study the difference in response between primigravida and multigravida. 4. To study whether foley induction prior to intracervical gel instillation was helpful. 5. To study whether oxytocin augmentation was needed. 6. To study the correlation of induction of labour with induction to delivery interval. 7. To study the impact of induction of labour on maternal morbidity, evaluated in terms of PPH. 8. To study the effect of induction of labour on neonatal morbidity, evaluated in terms of whether or not the baby had NICU admission. 9. To study the factors for a successful induction of labourin terms of parity, gestational age, Modified Bishop’s score and mode of delivery. 10. To study the cost effectiveness and justification of induction of labour for logistic reasons. MATERIALS AND METHODS: The study was carried out at the Department of Obstetrics and Gynaecology, Chengalpattu Medical college and Hospital, Chengalpattu during the period of January 2018 to December 2018. STUDY DESIGN: Cross-Sectional Study. SAMPLE SIZE: 250. INCLUSION CRITERIA: 1. All inductions with intracervical PGE2 gel induction with gestational age > 37 weeks. 2. Medical disorders-GHT, GDM, Rh negative pregnancy, 3. Oligohydramnios, 4. Postdated pregnancy, 5. Intrauterine growth restriction. EXCLUSION CRITERIA: 1. All cases with gestational age <37 weeks. 2. Previous cesarian section/Hysterotomy 3. Cephalopelvic disproportion. 4. Antepartum haemorrhage. 5. Pelvic tumours. 6. Local infections. 7. Malpositions 8. Intrauterine fetal demise. CONCLUSION: ◈ Intracervical PGE2 is an effective method of cervical ripening. ◈ When PGE2 gel is combined with prior foley induction and oxytocin augmentation in an unfavourable cervix helped cervical ripening. ◈ The induction to labour interval and induction delivery interval was significantly less,ie,