Skip to main content Accessibility help
×
Home
Hostname: page-component-59b7f5684b-vcb8f Total loading time: 0.907 Render date: 2022-10-05T18:37:52.384Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": true, "useSa": true } hasContentIssue true
This chapter is part of a book that is no longer available to purchase from Cambridge Core

60 - Induction of Labor and Termination of the Previable Pregnancy

from Section 6 - Late Prenatal – Obstetric Problems

Luis Sanchez-Ramos
Affiliation:
Department of Obstetrics & Gynecology, University of Florida, Jacksonville, FL, USA
Isaac Delke
Affiliation:
Professor of Obstetrics & Gynecology, University of Florida College of Medicine, and Chief, Division of Maternal-Fetal Medicine, Obstetric Services, Obstetrics & Gynecology, University of Florida Health, Jacksonville, Florida, USA
Philip Steer
Affiliation:
Imperial College London
Carl Weiner
Affiliation:
University of Kansas
Bernard Gonik
Affiliation:
Wayne State University, Detroit
Stephen Robson
Affiliation:
University of Newcastle
Get access

Summary

Induction of Labor

Introduction

Labor induction is the stimulation of regular uterine contractions before the spontaneous onset of labor, using mechanical or pharmacologic methods in order to generate progressive cervical dilatation and subsequent delivery. Although the term generally refers to patients who are at term, it is also employed for women from 20 weeks’ gestation. It is important to distinguish labor induction from augmentation, which refers to stimulation of uterine contractions when spontaneous contractions during labor have been considered inadequate.

Induction of labor is an important and common clinical procedure in obstetrics. In the United States, the percentage of singleton births that were induced increased nearly every year from 1990 to 2010, when it reached a high of 23.8%, after which it declined to 23.7% in 2011 and 23.3% in 2012. One of the main reasons for the more recent decline is the reduced number of inductions at less than 39 weeks’ gestation, a trend that has been present since 2006.

Indications and Contraindications

Generally, labor induction is indicated when the benefits of delivery to the mother or fetus outweigh the potential risks of continuing the pregnancy. The most appropriate timing for labor induction is the point at which the maternal or perinatal benefits are greater if the pregnancy is interrupted than if the pregnancy is continued. Ideally, most pregnancies should be allowed to reach term, with the onset of spontaneous labor being an important indication of likely fetal maturity and therefore the sign of physiologic termination of pregnancy. However, occasionally a woman is best delivered before the spontaneous onset of labor. Commonly accepted indications for labor induction are listed in Table 60.1. Of the standard indications for labor induction, pregnancyinduced hypertension and postdate pregnancies are among the most common, accounting for more than 80% of reported inductions.

Given that there is an indication for induction, the risks to mother and fetus must then be considered, to make sure that the benefit outweighs these risks. The risks to the mother are mainly related to any increased chance that she will need operative delivery (particularly important if the cervix remains “unripe” or “unfavorable for induction”), compared with labor following the spontaneous onset of labor. The risks to the fetus are those of prematurity.

Type
Chapter
Information
High-Risk Pregnancy: Management Options
Five-Year Institutional Subscription with Online Updates
, pp. 1709 - 1749
Publisher: Cambridge University Press
First published in: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×