Induction of Labour

Abstract

Induction of labour is defined as use of external means for artificially stimulating the uterus before the spontaneous onset of labour pains. Labour induction ensures delivery of the fetus at an optimum time when delivery is more beneficial for the fetus, than the risks involved in continuing the pregnancy. Almost 25 % of labours are induced for some reason or another.

Post term pregnancy - NICE guidelines recommend that IOL should be considered for women beyond 41weeks of pregnancy.  

Hypertensive disorders in pregnancy - Evidence indicates that IOL can lower the risk of poor maternal and neonatal outcomes in women having severe gestational hypertension/eclampsia.

Foetal growth restriction - Induction of labour may help prevent stillbirths and improve neonatal outcomes in FGR.

Diabetes in pregnancy - There is lot of debate about the timing of IOL in women with uncomplicated diabetes and those with severe diabetes.

PROM - Inducing labour in cases of PROM reduces the rate of endometritis and of chorioamnionitis and admissions to a NICU. 

Intrauterine Fetal Demise - immediate induction of labor is advisable for preventing psychological trauma and related complications.

Twin pregnancy - IOL is not recommended routinely in uncomplicated twin pregnancies.  

Elective induction/IOL on maternal request - There is no advantage of elective induction in absence of definite maternal and fetal indications.

Whether labour can be induced depends on the status of the uterine cervix. Assessment of the cervix is traditionally done with the help of Bishop’s Score and the modified Bishop’s Score. Also correct selection of patients is necessary for labour induction. Labour should not be induced in situations where vaginal delivery is contraindicated. Common methods used for IOL are Foley’s catheter, amniotomy, oxytocin and prostaglandins in various forms. Risks associated with labour induction can be hyper-stimulation of the uterus and the associated risk of fetal heart rate abnormalities. IOL should be done judiciously with the best available options to ensure a reasonable chance of success of induction.