Induction of Labor: A Comparison of Guidelines

AlKhalifa, Muneera Ahmed; Hsu, Stephanie; ElHassan, Nusiba; AlAnsari, Basma; Ismael, Rehab; Raza, Gulmeen; Malas, Hosni; Ismail, Mohd Iswadi

doi:10.26502/ogr081

Cited by 5 publications

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“… 2 , 3 , 4 , 5 , 6 Several national and international clinical guidelines for labour induction have been established. 7 , 8 , 9 , 10 While these guidelines identify both maternal and fetal clinical conditions as potential indications for induction/augmentation, there are variations in the specific indications and contraindications within them. 7 , 10 Some additionally suggest offering pregnant women the option to decide on labour induction/augmentation after providing them with relevant information.…”

Section: Introductionmentioning

confidence: 99%

“… 7 , 8 , 9 , 10 While these guidelines identify both maternal and fetal clinical conditions as potential indications for induction/augmentation, there are variations in the specific indications and contraindications within them. 7 , 10 Some additionally suggest offering pregnant women the option to decide on labour induction/augmentation after providing them with relevant information. 7 , 10 This is consistent with the modern practice of shared decision making, enabling maternal autonomy through information provision and choice.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India

Cheng,

Zahir,

Carolin

et al. 2024

The Lancet Regional Health - Southeast Asia

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India

Cheng,

Zahir,

Carolin

et al. 2024

The Lancet Regional Health - Southeast Asia

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“…7–11 While these guidelines identify both maternal and fetal clinical conditions as potential indications for induction/augmentation, there are variations in the specific indications and contraindications within them. 7 11 Some additionally suggest offering pregnant women the option to decide on labour induction/augmentation after providing them with relevant information. 7 11 This is consistent with the modern practice of shared decision making, enabling maternal autonomy through information provision and choice.…”

Section: Introductionmentioning

confidence: 99%

“…7 11 Some additionally suggest offering pregnant women the option to decide on labour induction/augmentation after providing them with relevant information. 7 11 This is consistent with the modern practice of shared decision making, enabling maternal autonomy through information provision and choice. Therefore, there may be clinical and non-clinical factors influencing the decisions for labour induction and augmentation.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6] Several national and international clinical guidelines for labour induction have been established. [7][8][9][10][11] While these guidelines identify both maternal and fetal clinical conditions as potential indications for induction/augmentation, there are variations in the specific indications and contraindications within them. 7 11 Some additionally suggest offering pregnant women the option to decide on labour induction/augmentation after providing them with relevant information.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India

Cheng,

Zahir,

Solomi V

et al. 2023

Preprint

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OBJECTIVETo investigate clinical and non-clinical factors influencing labour induction and augmentation in pregnant women in India.DESIGNProspective cohort study of 9305 pregnant women.SETTING13 tertiary and community hospitals in six states across India.PARTICIPANTSWomen ≥18 years of age and planning a vaginal birth in the study hospital were recruited in the third trimester of pregnancy (≥28 weeks of gestation) and followed-up during labour and up to 48 hours of childbirth.MAIN OUTCOME MEASURESOutcomes were induction and augmentation of labour as per childbirth records. Maternal and fetal clinical conditions in current pregnancy were abstracted from medical records at recruitment and after childbirth, and classified based on guidelines to generate induction- related clinical indication groups: (i) ≥2 indications, (ii) one indication, (iii) no indication and (iv) contraindication. Non-clinical factors included self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records at recruitment. Multivariable logistic regression analyses were performed to identify independent associations of induction and augmentation of labour with the clinical and non- clinical factors.RESULTSAmong 9305 women, over two-fifth experienced labour induction (n=3936, 42.3%) and about a quarter had labour augmentation (n=2537, 27.3%). The majority who received labour induction/augmentation had at least one or more clinical indications, but around 34% did not have an indication. Compared with women with ≥2 indications, those with one (adjusted odds ratio 0.50, 95% confidence intervals 0.42 to 0.58) or no (0.24, 0.20 to 0.28) indication or with contraindications (0.12, 0.07 to 0.20) were less likely to be induced, adjusting for non-clinical characteristics. These associations were similar for augmentation of labour (0.71, 0.61 to 0.84, for one indication; 0.47, 0.39 to 0.55 for no indication; 0.17, 0.09 to 0.34 for contraindications). Several maternal demographic, healthcare utilization and socio-economic factors were independently associated with labour induction and augmentation.CONCLUSIONSDecisions about induction and augmentation of labour in our study population in India were largely guided by clinical recommendations but in nearly a third, there was no clinical indication based on guidelines. Further research is required to understand the complex influence of clinical need and socio-demographic factors on labour induction/augmentation in the context of risk and safety.What is already known on this topicSeveral established international and national guidelines recommend specific clinical indications and/or contraindications for induction of labour.Pregnant women are also given the option to decide on labour induction and/or augmentation after providing relevant informationWhat this study addsCompared to women with at least two clinical indications as per guidelines, those with one or no indication or with contraindications were less likely to be induced or augmented, independent of other non-clinical maternal characteristics.In a third of the participants, there was no clinical indication for induction/augmentation of labour based on guidelines.Several non-clinical factors including maternal demographic, healthcare utilization and socio-economic factors influenced the decision for labour induction and augmentation, which in turn could be due to women’s choice or clinicians’ unconscious bias and warrants further research.

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Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India

Cheng,

Zahir,

Solomi

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy.MethodsIn a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (≥28 weeks of gestation) and blood loss after childbirth during follow‐up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin ≥10 g/dL; moderate: hemoglobin 7 to 9.9 g/dL; severe: hemoglobin <7 g/dL), while PPH was defined based on blood loss volume (vaginal births: ≥500 mL or cesarean sections: ≥1000 mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders.ResultsPPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (P = 0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29–9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42–3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia.ConclusionThe risk of PPH is higher in women who have moderate–severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively.

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Induction of Labor: A Comparison of Guidelines

Cited by 5 publications

References 0 publications

Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India

Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India

Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India

Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India

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