From the Guidelines
Induction of labor should be performed when there are clear medical indications, and the method used should be chosen based on the individual patient's situation, with careful consideration of the risks and benefits, as indicated by the most recent guidelines from the American Academy of Family Physicians 1. The process of induction typically begins with cervical ripening if the cervix is unfavorable (Bishop score <6), using methods like:
- Prostaglandin E2 (Cervidil or Prepidil)
- Misoprostol (25-50 mcg vaginally every 4-6 hours), although its use is contraindicated in women with a previous cesarean delivery due to the risk of uterine rupture 1
- Mechanical methods such as a Foley catheter, which has been associated with a lower risk of uterine rupture compared to misoprostol 1 Once the cervix is favorable, oxytocin (Pitocin) is administered intravenously, starting at 1-2 mU/min and increasing by 1-2 mU/min every 30-60 minutes until adequate contractions occur (3-5 contractions in 10 minutes) 1. Continuous fetal monitoring is essential during induction to detect any signs of fetal distress. Amniotomy (artificial rupture of membranes) may be performed once the cervix is dilated to 3-4 cm to augment labor progress. The entire induction process can take 24-48 hours, particularly for first-time mothers with unfavorable cervices. It is crucial to carefully evaluate the individual patient's situation and choose the most appropriate method for induction, taking into account the potential risks and benefits, as well as the patient's medical history and current condition, as recommended by the American College of Obstetricians and Gynecologists 1.
From the FDA Drug Label
Oxytocin Injection, USP (synthetic) is indicated for the medical rather than the elective induction of labor. Antepartum Oxytocin Injection, USP (synthetic) is indicated for the initiation or improvement of uterine contractions, where this is desirable and considered suitable, in order to achieve early vaginal delivery for fetal or maternal reasons It is indicated for (1) induction of labor in patients with a medical indication for the initiation of labor, such as Rh problems, maternal diabetes, pre-eclampsia at or near term, when delivery is in the best interest of mother and fetus or when membranes are prematurely ruptured and delivery is indicated;
Induction of Labor with oxytocin (IV) is indicated for medical reasons, such as:
- Rh problems
- Maternal diabetes
- Pre-eclampsia at or near term
- Prematurely ruptured membranes Oxytocin (IV) is not recommended for elective induction of labor 2. The dosage of oxytocin for induction or stimulation of labor is determined by uterine response, with an initial dose of no more than 1 to 2 mU/min, and gradual increases in increments of no more than 1 to 2 mU/min until a contraction pattern similar to normal labor is established 2.