A systematic scoping review of clinical indications for induction of labour

Abstract

Background The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. Methods A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. Results 68 studies were included which related to post-term pregnancy (15), hypertension/preeclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42

Study of maternal and fetal outcome in pregnancy beyond 40 weeks: a prospective observational study at a tertiary institute

“…450)". 19 However, studies compared outcomes from induction at 41 weeks gestation and expectant management until 42 weeks gestation and found not only an increased risk of interventions but a higher cesarean delivery rate in the group that underwent induction at 41 weeks. 20,21 Cochrane review concluded that policy of labor induction compared with expectant management is associated with fewer perinatal deaths and cesarean sections.…”

Inter-hospital and inter-disciplinary variation in planned birth practices and readiness for change: a survey study

“…This study found variation in IOL practices, with only 28.7% of units inducing labour for breech presentation, 70.2% for a previous caesarean, 45.7% for suspected fetal macrosomia without diabetes and 63.8% for fetal growth restriction. Inter-hospital variation in indications for IOL is not surprising given the considerable uncertainty in the literature and clinical guidelines around what constitutes best-practice [ 17 , 18 , 40 ]. Variation may relate to uncertainty and confusion in the literature about when to recommend IOL and the consequences of IOL at that specific gestation for the particular indication of IOL [ 40 ].…”

“…Inter-hospital variation in indications for IOL is not surprising given the considerable uncertainty in the literature and clinical guidelines around what constitutes best-practice [ 17 , 18 , 40 ]. Variation may relate to uncertainty and confusion in the literature about when to recommend IOL and the consequences of IOL at that specific gestation for the particular indication of IOL [ 40 ]. While it was traditionally thought that IOL increased the risk of CS, recent evidence suggests otherwise [ 41 ], and there remains considerable debate around the circumstances in which IOL should be offered.…”

Fetomaternal Outcome Among the Pregnant Women Subject to the Induction of Labor

“…The primary indicator of the chances of success is the state of the cervix. A cervix that is not ripe increases the likelihood of a non-vaginal delivery [6]. Given that there is an increased progression in perinatal mortality and fetal compromise with gestation extending over 37 weeks, it is during weeks 37 and 41 that induction of labor has the massive potential to better neonatal outcomes [7].…”