From the Research
Introduction to Induction of Labor (IOL)
Induction of labor is a common procedure undertaken when the benefits of prompt delivery outweigh the risks of expectant management, as noted in 1. The goal of labor induction is to ensure the best possible outcome for mother and newborn.
Indications for Induction of Labor
The indications for induction of labor include situations where maternal and fetal risks of remaining pregnant outweigh the risks of delivery, such as gestational diabetes, hypertensive disorders of pregnancy, intrahepatic cholestasis of pregnancy, and post-term pregnancies, as discussed in 2. Other common indications include conditions where the risks of continued gestation are higher than the potential risks associated with the procedure, as mentioned in 3.
Methods of Induction of Labor
Several methods are available for induction of labor, including:
- Pharmacologic methods, such as oxytocin and prostaglandins
- Mechanical methods, such as cervical ripening and amniotomy
- Combined use of amniotomy and intravenous oxytocin, which is generally the most effective approach for women with a favorable cervix, as stated in 1
- Cervical ripening techniques, which facilitate softening, thinning, and dilation of an unfavorable cervix, as discussed in 3 and 4
Considerations for Induction of Labor
When selecting a method for induction of labor, factors such as cervical assessment, indication for induction, clinical presentation and history, safety, cost, and patient preference should be considered, as noted in 1. The timing of induction, particularly in post-term pregnancies, may also vary depending on the guidelines followed, as mentioned in 5.
Guidelines for Induction of Labor
Various medical societies, including the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynaecologists of Canada, the National Institute for Health and Care Excellence, and the World Health Organization, have published guidelines on induction of labor, as summarized in 5. These guidelines provide recommendations on clinical indications, methods, and management of uterine tachysystole in cases of induction of labor.
Treatment and Management
Treatment and management of induction of labor may involve:
- Membrane sweeping
- Mechanical methods, such as cervical ripening
- Prostaglandins
- Oxytocin, which may be administered intravenously
- Amniotomy, which may be considered a method of induction of labor, as noted in 5
- Management of uterine tachysystole, which is an important consideration in cases of induction of labor, as discussed in 5
Caveats and Differentials
It is essential to consider the potential risks and benefits of each method and to individualize care based on the patient's specific needs and preferences, as noted in 4. The use of certain methods, such as misoprostol, may be contraindicated in certain situations, as mentioned in 5.