Induction of labor

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The induction of labor is the artificial triggering of birth before the onset of labor by various hormonal substances.

Induction of labor in humans

In humans , induction of labor is the triggering of labor in the pregnant uterus before it begins by itself. In parallel, the term priming is often used, which means a cervical maturation process - triggered by prostaglandin  . This priming changes the consistency of the cervix and the sensitivity of the uterine muscles to oxytocin .

Reasons for an introduction

The most common scientifically proven reasons that make an introduction useful include:

Other reasons, such as “suspected macrosomia” and non-medical reasons (the woman's wish), are sometimes very critically discussed. In an American study it was shown that the rate of discharges before the 39th week of pregnancy could be reduced from 27% to 6% by obtaining a second opinion.

Clear reasons that speak against induction of labor (contraindications) are:

Choice of the optimal delivery method

While only introduction by oxytocin was common until the mid-1970s, there are now more than 20 different introduction methods. Both the pregnant woman concerned and the obstetric team have requirements for the method of choice:

  • The mother should be satisfied with the method chosen
  • The vaginal delivery should take place in less than 24 hours: this item includes a brief labor time, at the lowest possible rate of vaginal operative deliveries and cesarean sections .
  • The lowest possible rate of: tachysystole (= more than 5 contractions in 10 minutes over 20 minutes), uterine hypertension (labor duration longer than 2 minutes), changes in the heart rate in children, maternal complications such as uterine rupture
  • The method chosen should be economically viable; H. the shortest possible length of stay for the woman in the obstetric department

At the moment there is no method that can meet all of these requirements.

A higher parity , a body mass index of less than 35, the country of origin, a maternal age of less than 35, a gestational age of more than 37 weeks, a low fetal weight and a value greater than six in the Bishop score .

Introductory methods

Oxytocin

Induction with intravenously administered oxytocin is the most common method used worldwide. It is sometimes combined with an amniotomy (opening of the amniotic sac). Studies have shown that, in comparison with "waiting", the birth occurs significantly faster, but also more frequent caesarean sections. The administration of oxytocin is associated with a down-regulation of the oxytocin receptors, and in this context the current practice of oxytocin infusion is viewed critically in some cases. Postpartum hemorrhages are more common in women who received oxytocin prepartally , which is attributed to a decrease in and desensitization of the oxytocin receptors. There are also indications that the perinatal use of oxytocin can have an unfavorable effect on the initial mother-child bond and that later difficulties with breastfeeding and excessive crying can occur more often in infancy .

Prostaglandin E2

When priming with prostaglandin E2 , this is inserted intra- cervically in the form of tablets, pessaries or gel. There is no uniform recommendation on the amount of dosage. This method is recommended compared to oxytocin if the Bishop score is less than six; the caesarean section does not seem to be increased.

Misoprostol

Misoprostol is a synthetically produced prostaglandin E1 analogue that can be administered orally or vaginally. It is inexpensive and, compared to induction with prostaglandin E2, leads to vaginal births more frequently within 24 hours. But contractions (hyperstimulation of the uterus) are also more common , which is why it must not be used in women who have had operations on the uterus.

According to Peter Husslein , professor of obstetrics, there is a greater risk of a ruptured uterus or contractions when using Cytotec (trade name of Misoprostol) than when using other alternatives. A contraction storm could cause the child to suffer from a lack of oxygen. There is insufficient reason to use this dangerous unregistered drug for obstetrics. However, patients are “not always fairly informed”.

Naturopathic introductory methods

The contractions cocktail and clove oil tampons , which are applied through the vagina, are known. A randomized controlled study on the use of acupuncture in addition to drug induction did not show a significant reduction in the time to delivery.

Mechanical methods

In the past, mechanical methods, such as egg solution or the artificial opening of the amniotic sac ( amniotomy ) to induce labor were also common. These methods are rarely used today, as the amniotomy in particular involves numerous risks for mother and child.

Historical methods to induce an artificial premature birth were, for example, hot full baths or the use of electricity.

Induction of labor in pets

Since the hormonal maintenance of pregnancy has peculiarities in the various mammals, the drugs used to induce labor also differ. In animals in which the pregnancy-maintaining progesterone is produced in the corpus luteum, prostaglandins and glucocorticoids come into consideration, in the case of production in the placenta, glucocorticoids. Indications for induction of labor are above all severe diseases of the dam, in cattle also transmission, in domestic pigs also the synchronization of farrowings for technological reasons. The problem of children especially may unripe fruits are in deliberate viability (unknown cover date), insufficiently dilated birth canal ( dystocia ), an immature placenta ( placenta ) and an insufficiently developed mammary gland (little immunoglobulins in colostrum ).

In horses , pregnancy is maintained from the 130th day through the progesterone production of the placenta alone . In mares, labor can be induced solely by oxytocin via a continuous drip infusion, since the closure of the cervix is ​​relatively small.

In domestic cattle , labor can be induced from the 270th day of gestation with prostaglandin F2α or synthetic F2α analogues such as cloprostenol and tiaprost , which lead to the breakdown of the corpus luteum ( luteolysis ). Cattle give birth after 3 days, but in most cases this type of induction leads to postpartum retention. In cattle, sheep and goats , induction of labor with highly effective glucocorticoids (e.g. dexamethasone , flumethasone ) is possible if the unborn child is still alive. In cattle, they are initially administered in low doses for 4 days in order to promote the lung maturation of the calf, and then in high doses on two consecutive days, combined with prostaglandin F2α on the last day. The birth begins 24 hours after the last dose.

In pigs , labor can be induced by prostaglandin F2α or cloprostenol between the 110th and 113th day of gestation, with oxytocin or carbetozin being added to support labor after 24 hours .

In domestic dogs , birth can be triggered with cabergoline or aglepristone from the 48th day of gestation . Cabergoline is a prolactin inhibitor, the effectiveness of which is based on the fact that the late pregnancy in dogs is mainly maintained by prolactin. Aglepriston is an antiprogestin which blocks the receptors for progesterone on the uterus. At the onset of childbirth, labor is supported by the administration of oxytocin.

In the practice, induction of labor is almost never necessary for domestic cats ; Aglepriston can also be used here.

literature

Individual evidence

  1. ^ Labor induction - definition. Mayo Clinic, accessed March 2, 2014 .
  2. ↑ Reducing Inappropriate Induction of Labor: Case Study of Intermountain Health Care ( Memento from October 1, 2010 in the Internet Archive )
  3. ↑ AJ Kelly, B. Tan: Intravenous oxytocin alone for cervical ripening and induction of labor . Cochran Database Syst Rev, 200 (3)
  4. ↑ T. Bossmar: Treatment of preterm labor with oxytocin and vasopressin antagonist the atosiban . In: J. Perinat. Med. , 1998, 26 (6), pp. 458-65. Quoted from Julia Wölker: Comparative in vitro study on the relaxation effect of atosiban, glycerol trinitrate and nifedipine on the myometrium of premenopausal women (with clinical reference to dysmenorrhea). In: Dissertation, Medical Faculty of the Charité, Universitätsmedizin Berlin. Retrieved March 13, 2011 . P. 18 (PDF) and p. 55 (PDF)
  5. ↑ M. Akerlund: Vasopressin and oxytocin in normal reproduction and in the pathophysiology of preterm labor and primary dysmenorrhoea. Development of receptor antagonists for therapeutic use in these conditions , Rocz Akad Med Bialymst. 2004, 49, pp. 18-21
  6. ↑ Susanne Mack: Hormones at birth - current knowledge . In: Hebamme 2010, 23 (4), pp. 243-247, doi: 10.1055 / s-0030-1267807
  7. ↑ Robinson C, Schumann R, Zhang P, et al. Oxytocin-induced desensitization of the oxytocin receptor. American journal of obstetrics and gynecology 2003; 188 (2): 497-502.23.
  8. ↑ Said S, Geary M. Prevention of obstetric haemorrhage. Fetal and Maternal Medicine Review 2007; 18 (3): 257-88.24.
  9. ↑ Phaneuf S, Linares BR, TambyRaja RL, et al. Loss of myometrial oxytocin receptors during oxytocin-induced and oxytocin-augmented labor. J Reprod Fertil 2000; 120 (1): 91-97.
  10. ↑ Robinson et al , Said et al and Phaneuf et al are cited from: Karin Bischoff, Britta Lang, Edith Motschall, Christine Schmucker: Uterotonics (oxytocin) in cesarean delivery . Evidence map. In: www.bundesgesundheitsministerium.de. January 19, 2017, accessed on November 1st, 2019 : "The increase in PPH prepartally oxytocin got administered rate after giving birth early, often due to the fact that oxytocin may have in this stage of labor, a reduction and desensitization of the oxytocin receptors result." S . 8th.
  11. ↑ Christof Plothe: The perinatal administration of oxytocin and its possible consequences on the human psyche . In: International Journal of Prenatal and Perinatal Psychology and Medicine , Volume 21, Mattes Verlag, Heidelberg 2009, p. 10 (PDF).
  12. ↑ Katrin Langhans: "Cytotec has caused numerous maternal deaths". In: www.sueddeutsche.de. February 12, 2020, accessed February 13, 2020 .
  13. ^ A randomized controlled trial of acupuncture for initiation of labor in nulliparous women . In: J Matern Fetal Neonatal Med , 2006 Aug, 19 (8), pp. 465-470
  14. ↑ A. Sippel: On the labor-inducing effect of hot full baths. In: Centralblatt für Gynäkologie. Volume 10, No. 14, April 3, 1886, p. 212 f.
  15. ↑ Arthur Hoffmann: On the initiation of artificial premature birth through hot full baths. In: Centralblatt für Gynäkologie. Volume 10, No. 32, August 7, 1886, pp. 513-515.
  16. ↑ L. Litschkus: To initiate the artificial premature birth by means of the induction current . Ibid. 51, December 18, 1886, pp. 825-834.