Induction of labor
| Labor induction | |
|---|---|
| Intervention | |
| ICD-9-CM | 73.0-73.1 |
Labor induction is artificially stimulating childbirth.
Commonly accepted medical reasons for induction include:
Induction of labor in those who are either at or after term improves outcomes for the baby and decreases the number of C-sections performed.
Methods of inducing labor include both pharmacological medication and mechanical or physical approaches.
Mechanical and physical approaches can include artificial rupture of membranes or membrane sweeping. The use of intrauterine catheters are also indicated. These work by compressing the cervix mechanically to generate release on prostaglandins in local tissues. There is no direct effect on the uterus.
Pharmacological methods are mainly using either dinoprostone (prostaglandin E2) or misoprostol (a prostaglandin E1 analogue)
The American Congress of Obstetricians and Gynecologists has recommended against elective induction before 41 weeks if there is no medical indication and the cervix is unfavorable. However, recent studies contradict this view. One recent study indicates that labor induction at term or post-term reduces the rate of caesarean section by 12%, and also reduces fetal death. On the other hand, observational/retrospective studies have shown that non-indicated, elective inductions before the 41st week of gestation are associated with an increased risk of requiring a caesarean section. Randomized clinical trials have not been used to study this question. However, it has been found that multiparous women who undergo labor induction without medical indicators are not predisposed to cesarean sections. Doctors and patients should have a discussion of risks and benefits when considering an induction of labor in the absence of an accepted medical indiction.
Studies have shown a slight increase in risk of infant mortality for births in the 41st and particularly 42nd week of gestation, as well as a higher risk of injury to the mother and child. Due to the increasing risks of advanced gestation, induction appears to reduce the risk for cesarean delivery after 41 weeks gestation and possibly earlier.
Inducing labor before 39 weeks in the absence of a medical indication, like hypertension, IUGR, or pre-eclampsia, increases the risk of complications of prematurity including difficulties with respiration, infection, feeding, jaundice, neonatal intensive care unit admissions, and perinatal death.
The odds of having a vaginal delivery after labor induction are assessed by a "Bishop Score". However, recent research has questioned the relationship between the Bishop score and a successful induction, finding that a poor Bishop score actually may improve the chance for a vaginal delivery after induction. A Bishop Score is done to assess the progression of the cervix prior to an induction. In order to do this, the cervix must be checked to see how much it has effaced, thinned out, and how far dilated it is. The score goes by a points system depending on five factors. Each factor is scored on a scale of either 0-2 or 0–3, any score that adds up to be less than 5 holds a higher risk of delivering by cesarean section.
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