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- 1. SEMINAR ON AUGUMENTATIONOF LABOUR P.G. COLLEGE OF NURSING, BHILAI C.G.
- 2. Augmentation oflabour is a clinical intervention used to enhance or accelerate the progress of spontaneous labour when it becomes prolonged or ineffective. It is commonly employed in cases where uterine contractions are weak, infrequent, or inadequate to bring about cervical dilatation and fetal descent. Unlike induction, which initiates labour artificially, augmentation is carried out after the onset of spontaneous labour to support and stimulate the natural process.
- 3. Definition: “Artificial stimulationof uterine contractions that have become inadequate or ineffective, to increase the frequency, duration, and intensity of contractions.” ACC. TO DC DUTTA
- 4. Indications for Augmentationof Labour: •Ineffective uterine contractions (hypotonic uterine activity) •Prolonged latent phase or active phase of labour •Premature rupture of membranes (PROM) •Failure of cervical dilatation progression •Inadequate descent of presenting part
- 5. Methods of Augmentation 1.Amniotomy (Artificial Rupture of Membranes -ARM) 2. Oxytocin Infusion 3. Prostaglandins (less commonly used in augmentation)
- 6. 1. Amniotomy (ArtificialRupture of Membranes - ARM): Amniotomy, also known as Artificial Rupture of Membranes (ARM), is a medical procedure in which the amniotic sac (bag of waters) is intentionally ruptured using a sterile instrument to stimulate or augment labour. It is one of the most common and oldest techniques used to accelerate slow labour. Purpose in Augmentation: 1.To enhance uterine contractions 2.To facilitate cervical dilatation 3.To enable monitoring of amniotic fluid (color, quantity) 4.To apply internal fetal monitoring if needed
- 7. Mechanism ofAction: Rupture of membranes leads to the release of prostaglandins, which stimulate uterine contractions. With loss of amniotic fluid, the presenting part (usually the fetal head) descends, putting direct pressure on the cervix enhances → dilatation.
- 8. Indications for Amniotomy Slowing progress of labour (especially in active phase) To augment inadequate uterine contractions As a part of active management of labour To allow internal monitoring (e.g., scalp electrode, intrauterine pressure catheter) When cervix is at least 3–4 cm dilated and head is engaged
- 9. Contraindications Unengaged presentingpart (risk of cord prolapse) Mal-presentation (e.g., breech, transverse) High presenting part in preterm labour Placenta previa or vasa previa HIV or Hepatitis B/C (to reduce transmission risk)
- 10. Procedure Explain theprocedure and take consent. Ensure fetal head is well engaged. Use a sterile Amnihook or Kocher’s forceps. Insert instrument gently through the cervical opening and rupture the sac. Observe amniotic fluid for color, amount, and odor.
- 11. Advantages No medicationinvolved Allows monitoring of amniotic fluid Risks Infection Umbilical cord prolapse Fetal distress due to cord compression
- 12. 2. Oxytocin Infusion Synthetic hormone administered via IV drip Increases frequency and intensity of contractions Dosage Start with 1–2 mU/min, increase gradually every 30–60 min Maximum usually 20–30 mU/min (as per protocol)
- 13. Advantages Controlled andtitrated dosage Effective in initiating labour progress Risks Hyperstimulation of uterus Fetal distress Uterine rupture (in previous cesarean)
- 14. 3. Prostaglandins (lesscommonly used in augmentation) Prostaglandins are naturally occurring hormone-like substances that play a vital role in preparing the cervix and stimulating uterine contractions.While they are more commonly used for induction, in some cases, they may be utilized during augmentation of labour — especially when the cervix is unfavorable (unripe) or labour progress is slow even after it has started spontaneously.
- 15. Types of ProstaglandinsUsed PGE1 Analog – Misoprostol Synthetic prostaglandin E1 Available in tablet form (oral/vaginal) Common dose for augmentation: 25 mcg vaginally every 4–6 hours PGE2 Analog – Dinoprostone Synthetic prostaglandin E2 Available as vaginal gel, insert, or tablet Example: Cerviprime gel (0.5 mg), Propess vaginal insert
- 16. Mechanism of Action Cervical Ripening: Prostaglandins soften and dilate the cervix by altering collagen and increasing water content. Uterine Contractions:They stimulate smooth muscle contractions in the uterus, enhancing the frequency and intensity of labour contractions.
- 17. Indications for Usein Augmentation Inadequate uterine contractions after spontaneous labour onset Unfavorable cervix (low Bishop Score) Failure of progress despite ARM or low-dose oxytocin PROM with minimal contractions
- 18. Advantages Effective cervicalripening agent (especially Dinoprostone) Can reduce the need for oxytocin in some cases Useful in patients not responding well to oxytocin alone Non-invasive (especially vaginal route)
- 19. Nursing Responsibilities Monitorfetal heart rate (FHR) continuously Monitor uterine contraction pattern (frequency, duration, strength) Observe for signs of hyperstimulation (more than 5 contractions in 10 minutes) Check maternal vitals regularly Maintain strict input/output chart Emotional support to the mother
- 20. Complications of Augmentation Uterine hyper-timulation (tachysystole) Fetal hypoxia/distress Uterine rupture (especially in scarred uterus) Infection (if membranes ruptured early) Water intoxication (rare, with high-dose oxytocin)