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induction of labor

Indications: - may reduce perinatal mortality at 40 weeks of gestation [2] - labor induction at 41 weeks of gestation may be safer than waiting [5] - often performed at 39 weeks gestation in women of advanced maternal age (> 35 years) in order to lower risk of stillbirth [3] * success rates for achieving vaginal delivery after induction 70-80% [6] Procedure: - cervical ripening - balloon catheter dilatation - oral or vaginal prostaglandins * success rate similar with balloon catheter dilatation vs vaginal prostaglandin [6] * complications less frequent with balloon catheter dilatation [6] Complications: - induction of labor doubles risk of amniotic fluid embolism [1] - does not increase risk of need for Cesarean section [2,3] - increases risk of admission to neonatal special care unit [2] - endometritis], severe postpartum hemorrhage [6] - neonatal respiratory distress; neonatal infection [6] Notes: - elective induction of labor at 39 weeks - does not lower risk of neonatal complications or perinatal death [4] - reduces number of C-sections

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labor

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induction clinical procedure

References

  1. Kramer MS et al, Amniotic-fluid embolism and medical induction of labour: A retrospective, population-based cohort study. Lancet 2006, 368:1444 PMID: 17055946
  2. Stock SJ et al Outcomes of elective induction of labour compared with expectant management: population based study BMJ 2012;344:e2838 PMID: 22577197 http://www.bmj.com/content/344/bmj.e2838
  3. Walker KF et al Randomized Trial of Labor Induction in Women 35 Years of Age or Older. N Engl J Med 2016; 374:813-822. March 3, 2016 PMID: 26962902 http://www.nejm.org/doi/full/10.1056/NEJMoa1509117 - Grobman WA Induction of Labor and Cesarean Delivery. N Engl J Med 2016; 374:880-881. March 3, 2016 PMID: 26962908 http://www.nejm.org/doi/full/10.1056/NEJMe1516461
  4. Grobman WA, Rice MM, Reddy UM et al Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med 2018; 379:513-523. Aug 9, 2018 PMID: 30089070 https://www.nejm.org/doi/full/10.1056/NEJMoa1800566 - Greene MF Choices in Managing Full-Term Pregnancy. N Engl J Med 2018; 379:580-581. Aug 9, 2018 PMID: 30089068 https://www.nejm.org/doi/full/10.1056/NEJMe1807747
  5. Wennerholm LB et al Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial. BMJ 2019;367:l6131 PMID: 31748223 Free Article https://www.bmj.com/content/367/bmj.l6131 - Kenyon S et al When to induce late term pregnancies. BMJ 2019;367:l6486 PMID: 31748240 https://www.bmj.com/content/367/bmj.l6486
  6. Jones MN et al. Balloon catheters versus vaginal prostaglandins for labour induction (CPI Collaborative): An individual participant data meta-analysis of randomised controlled trials. Lancet 2022 Nov 12; 400:1681. PMID: 36366885 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01845-1/fulltext