Induction of labor

A method of artificially or prematurely stimulating childbirth.

Artificially initiates the process of effacement of the cervix dilatation, uterine contractions and eventually delivery of the baby.

Aims to end pregnancy via delivery, when continuation of the pregnancy could jeopardize the mother’s condition or the babies condition, and delivery ought to improve outcomes compared with continuing the pregnancy.

At present, labor is induced in 1/4 of pregnancies in high resource settings and in 1/10 of pregnancies in low income countries.

Approximately 16% of deliveries.

Worldwide 20-30% of deliveries are induced.

A substantial percentage of women in whom labor is induced have a unfavorable cervical finding including lack of cervical dilatation, cervical effacement of 25% or less, or posterior cervical position at the time of induction.

Associated complications of induction almost always treated by Caesaian section.

Indications for induction include: Postterm pregnancy, intrauterine fetal growth retardation, preclampsia, diabetes, oligohydramnios, premature rupture of the membranes, and remature termination of pregnancy, scheduling problems for delivery, fetal death in utero, and twin pregnancy continuing beyond 38 weeks.

In the presence of an unfavorable cervix, induction of labor starts with cervical ripening, which can be achieved with mechanical methods such as a Foley catheter, or with medications such as prostaglandin E1 or E2 analogues.

In women with an unfavorable cervix at term, induction of labor with oral misoptostol and foley catheter have similar safety and effectiveness.

Pregnancy induction is most likely to result in successful vaginal delivery when a woman is close to or in the early stages of labor.

The Bishop score may be used to assess the advisability of induction.

Oxytocin and prostaglandin E2 or dinoprostone are the agents most commonly used for cervical ripening and labor induction.

Use of vaginal misoprostol has demonstrated superiority over oxytocin or PGE2 with no associated significant increase in adverse maternal or neonatal outcome.

Methods for cervical ripening include mechanical methods such as transcervical Foley catheters, and pharmacological methods with prostaglandin E1 (misoprostol), and prostaglandin E2 preparations.

Membrane stripping, with the movement of a finger around the cervix to stimulate and/or separate the membranes around the baby from the cervix, causing a release of prostaglandins.

Induced labor tends to be more painful for the woman., and is associted with increased use of analgesics.

Elective induction was associated with a doubling of the rate of caesarean section .

When associated with an unripe cervix labor is prolonged and higher rates of failed induction, requiring cesarean delivery.

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