Induction of Labour

Indications for Induction of Labour

PLANNED DELIVERY

INDUCTION OF LABOUR

INDICATIONS

What are the indications for induction of labour?

The following table has been adapted from the RCOG guidelines:-

http://www.rcog.org.uk/resources/public/pdf/rcog-induction-of-labour. Pdf

Prolonged pregnancy	An ultrasound to confirm gestation should be offered before 20 weeks of gestation, as this reduces the need for induction for perceived post-term pregnancy. Women with uncomplicated pregnancies should be offered induction of labour beyond 41 weeks. From 42 weeks, women who decline induction of labour should be offered increased antenatal monitoring consisting of a twice weekly CTG and ultrasound estimation of maximum amniotic pool depth. Population studies indicate that, in women who are healthy and have otherwise uncomplicated pregnancies, perinatal mortality and morbidity is increased in pregnancies of more than 42 weeks. The risk of stillbirth increases from one per 3000 continuing pregnancies at 37 weeks to three per 3000 continuing pregnancies at 42 weeks to six per 3000 continuing pregnancies at 43 weeks. A similar increase in neonatal mortality is also reported.
Diabetes in pregnancy	Women who have pregnancies complicated by diabetes should be offered induction of labour prior to their estimated date for delivery. Induction of labour of term pregnancies in women with diabetes is associated with a reduced risk of macrosomia.
Prelabour rupture of the?membranes	Women with prelabour rupture of the membranes at term (over 37 weeks) should be offered a choice of immediate induction of labour or expectant management. Expectant management of women with prelabour rupture of the membranes at term should not exceed 96 hours following membrane rupture. There is no difference in operative delivery rates between induction versus a conservative approach in women with prelabour rupture of the membranes. A policy of induction of labour is associated with a reduction in infective sequelae for mother and baby.⁰⁰⁰¹
Maternal request prior to 41 weeks.	Where resources allow, maternal request for induction of labour should be considered when there are compelling psychological or social reasons and the woman has a favourable cervix. The risks of induction of labour for the mother will be equivalent to those of the general population. However, any potential benefits accrued are less easy to quantify. There is an increased risk of respiratory distress syndrome in the baby if labour is induced before term. Therefore, it is important that these risks are highlighted in any discussions regarding induction prior to term. There is insufficient evidence to allow comment on the risks associated with elective induction of labour for maternal request.

Examples of further complications that might necessitate induction of labour:-

Hypertension of pregnancy	These conditions need considerable care in determining the optimum time for delivery and whether induction of labour or caesarean section are indicated.
Rhesus Isoimunisation
Placental Insufficiency
Stillbirth
Fetal Macrosomia

Is it appropriate to induce labour for suspected fetal macrosomia?

Where

Suspected

Labour is often induced when the fetus is suspected to be macrosomic in order to reduce the risk of difficult operative delivery. Irion and Boulvain⁰⁰⁰² found that induction of labour for suspected fetal macrosomia in non-diabetic women did not appear to alter the risk of maternal or neonatal morbidity.

PLANNED DELIVERY

Previous Caesarean Section

Twins

Water Birth

Induction of Labour - Indications

Induction of Labour - Methods

This Website has been developed as a result of experience gained from its sister site - www.2womenshealth.com. Work on www.obstetric-health.com began in January 2007.
In addition to a general presentation of the facts, the author has expanded into areas of current debate.
For those without medical training, all medical terms in the text have a link providing an explanation. For those requiring more in depth, evidence based information, links to the abstracts of selected medical papers are provided. This area of the Web site is an ongoing project.
The views expressed in this e-book are those of the author although he would like to think that they are representative of the main body of current thinking. The author would not wish anyone to quote opinions expressed in this book as a basis for criticism of others who are no less entitled to their own beliefs and preferences.
DISCLAIMER
The aim of this e-book is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.