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3 - Induction of labour

Published online by Cambridge University Press:  21 August 2009

Alexander Heazell  and
John Clift
By
Rebekah Samangaya
Alexander Heazell
Affiliation:
University of Manchester
John Clift
Affiliation:
City Hospital, Birmingham
Rebekah Samangaya
Affiliation:
Specialist Registrar, Rochdale Hospital, Pennine Acute Hospitals, NHS Trust, Rochdale, UK
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Summary

Introduction

Induction of labour is defined as an intervention to artificially initiate uterine contractions to lead to cervical effacement and dilatation, and delivery of the baby. This definition incorporates women with intact membranes and those with spontaneous rupture of membranes who have not gone into labour. In the UK, about 20% of pregnancies are induced.

Indications for induction of labour

The indications for induction of labour (IOL) can be divided into fetal or maternal indications. It is important that IOL is initiated for a specific indication, due to the associated risks. The benefits of delivery should outweigh the risks of continuing the pregnancy.

Fetal

Post maturity

Prolonged pregnancy is the most common indication for IOL. Guidelines from the National Institute for Health and Clinical Excellence (NICE) recommend offering IOL to women between 41 and 42 weeks' gestation. This gestation is utilised due to the risk of stillbirth rising from 1 per 1000 pregnancies at 42 weeks to 2 per 1000 pregnancies at 43 weeks. Prolonged gestation can also be associated with an increase in intrapartum complications such as fetal distress.

Suspected fetal compromise

Suspected fetal compromise may be an indication for IOL. Placental insufficiency including intrauterine growth restriction (IUGR), reduced liquor volume, or an abnormal Doppler ultrasound of the umbilical artery is an indication for delivery of the baby, as is rhesus incompatibility where the fetus may be at risk of anaemia.

Keywords

induction of labourintra-uterine infectionintrauterine fetal deathobstetriciansultrasonographers
Type
Chapter
Information
Obstetrics for Anaesthetists , pp. 22 - 30
Publisher: Cambridge University Press
Print publication year: 2008

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References

National Institute for Health and Clinical Excellence. Inherited Clinical Guideline D. Induction of Labour. (London: Department of Health, 2001).
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