Augmentation of labor is a process where we stimulate the uterus to get the desired intensity, frequency and duration of contractions. In a woman who is already in an established labor, but the progression of labor is delayed. And this progress is delayed mainly because of poor uterine contractions. So here we can always augment the labor. Failure of progress of labor is a major indication for caesarian section. So in order to reduce this high incidence of Cesarean section in a woman, we have a drug which can be used to augment the labor. Whenever we plan for Augmentation of labor, two questions to be asked. Is the patient is in true labor? That is established labor, or have we ruled out cephalopelvic dysfunctions? If these two criteria’s have been fulfilled, then we have decided to go ahead with augmentation of labor, the patient should be hospitalized, the patient should be continuously monitored with for uterine contractions. So the fetal monitoring is required. So definitely an experienced nurse has to be next to a patient. So the goal here is just to get adequate uterine contractions without causing any distress to the baby, the labor has to happen. The dose of drugs depends upon so many criterias, like gestational age. So if it is nearing the turn, then the sensitivity of the uterus to the oxytocin is more compared to the preterm pregnancies and preexisting contraction patterns and the cervix what stage it is dilated and where is the statin of the head. So one of these criterias are fulfilled we go ahead with the augmentation. So there are three different methods for augmentation. First one is most commonly us the amniotomy. Amniotomy is nothing but the artificial rupture of the membranes. It is commonly used, very simple procedure. Here with the help of a gloves and, with the help of a very simple plastic device, with a hook, which is inserted through the vagina and we rupture the membrane. It stimulates the uterine contraction and shortens the labor durations. It doesn’t cause much discomfort. It is very simple procedure. Coming to the next method that is drug called as oxytocin. It is a synthetic hormone, which is very commonly used. It acts by stimulating the uterus, the uterine contraction and the desired stimulations like in intensity duration and frequency can be obtained with this drug. So it is given in infusion for with the help of a pump. Continuous infusion through the pump and the drug has to be diluted in Ringer’s lactate. About 10 units of syntocinon is diluted with 1000 ml of Ringer’s lactate. That gives dilution of about 10 milliunits in 1 ml. So it is usually it is started with 6 milli units per ml and monitor to about next 40 minutes, then again if the desired contractions are not obtained, then we increase it by another 6 milliunits, till we get the desired uterine contractions. Anytime in between if we get hyper stimulation, then the drug or the medicines can be discontinued. So half-life of this drug is about 3 to 5 minutes. So in another 10 to 15 minutes or half an hour time, the completely uterus is relaxed, again the fetal cardiac activity is normal, again it vna be started at half the dose, that is 3 milliunits per ml and then accelerated by 3 milliunits per ml. but the dose should never exceed 40 milliunits per ml. So it is a very useful drug and very routinely we use it. But continuous fetal monitoring and uterine contraction monitoring should be there to avoid complications. Then the third method is the combination of both, that is amniotomy as well as oxytocin. It is proved beyond doubt that when the combined method is used it is much better than oxytocin drug alone. So these are the three methods we use so with the use of augmentation methods, definitely C section rates have come down And complications like delivering hypoxic babies or hyper stimulation and rupture of the uterus has come down mainly because we are monitoring the fetus as well as the mother very well.

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