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INTRODUCTION

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Induction of labor is the artificial initiation of labor before its spontaneous onset. It should be considered when the benefits of earlier delivery outweigh the potential risks to the mother and baby associated with induction of labor and prolongation of pregnancy. A careful and well-documented discussion should be made between the health care provider and the patient and should include the reason for induction, method of induction, and risks associated with induction of labor. Some of the common indications for induction of labor are discussed below.

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Maternal Indications

PRELABOR SPONTANEOUS RUPTURE OF MEMBRANES  If membrane rupture occurs beyond 37 weeks and labor does not begin after 24 hours, induction of labor is appropriate and recommended to reduce the risk of infection to both the mother and the baby. If preterm (<37 weeks) spontaneous rupture of membranes occur, induction of labor should be considered after 34 weeks.

PREECLAMPSIA Induction of labor should be considered in women with gestational hypertension. In the presence of preeclampsia, toxemia, or other adverse conditions (to the mother or baby), induction of labor is recommended.

POLYHYDRAMNIOS There is no evidence to support routine labor induction in otherwise uncomplicated pregnancies with polyhydramnios. Induction of labor is sometimes carried out if an unstable lie places the woman at high risk for an umbilical cord prolapse if the membranes rupture spontaneously.

ANTEPARTUM BLEEDING Induction of labor may be indicated in cases of stable low-lying placenta and placental abruption in which bleeding is persistent.

INTRAUTERINE FETAL DEATH (IUFD) In cases of IUFD where there is evidence of ruptured membranes, infection, bleeding, or coagulopathy, immediate induction of labor is recommended. If the woman is otherwise well, labor induction may be delayed. Induction of labor may also be considered in women with a history of IUFD near term in past pregnancies. The timing of induction should be individualized but is usually carried out 1 week prior to the gestation of a previous stillbirth.

ELECTIVE When induction of labor is being carried out for the convenience of the patient and/or the doctor, it is called an elective induction. Elective inductions should be avoided as much as possible. In exceptional circumstances (e.g., a history of rapid labors or the patient lives far from a hospital), induction may be considered at or after 40 weeks.

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Fetal Indications

POSTTERM PREGNANCY There is strong evidence to support a recommendation of induction of labor between 41+0 and 42+0 weeks of gestation. Beyond 42+0 weeks, there is an increased risk of perinatal death and meconium aspiration to the baby. For the mother, the risk of cesarean section is reduced when induction of labor is carried out between 41+0 and 42+0 weeks gestation.

MATERNAL DIABETES There is a risk of fetal death in utero associated with insulin-dependent diabetes during the later weeks of pregnancy. In cases of preexisting diabetes or insulin-dependent diabetes or in the presence of complications associated with diabetes, labor induction is indicated. The timing of induction should be individualized.

INTRAUTERINE GROWTH RESTRICTION ...

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