Induction of Labour

Abstract

Induction of labour is one of the common obstetric interventions in the world with varied incidence rates between developed and developing countries. It is generally employed by obstetricians and physicians managing pregnant women when the risk of continuing such pregnancy is far greater than delivery at that said point. A detailed evaluation and indications for induction of labour should be done for every single woman. Methods of induction of labour could be pharmacological, mechanical or both; taking care to reduce or eliminate complications associated with this intervention. Decision for induction of labour should involve the most senior member of the team with a woman centered approach to care. Induction of labour carries multiple risks and complications compared with spontaneous onset of uterine contractions with increase tendency of operative vaginal delivery and caesarean section.

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

“…Compared with the WHO Global Survey of 20 Indian healthcare facilities in 2007-2008, 4 the present findings suggest a potential threefold increase in the prevalence of labour induction in India (from 12.8% in the WHO survey to 42.3% in our study) over two decades, with induction using pharmacological agents alone being the predominant method (77.4% in the WHO survey vs. 58.8% in our study). Also, the WHO Global Survey 4 and our study consistently found that fetal-related complications and hypertensive disorders in pregnancy were the most common indications for induction (representing at least 10% of inductions), and identified similar proportions of induction of labour without any clinical indication as per guidelines 8–10 23–25 (32.1% in WHO survey vs. ∼31% in our study). The increased utilization of induction of labour may be partially explained by improved diagnosis or increasing prevalence of maternal and/or fetal complications, but this also depends on what is reported in the labour management records.…”

“…Approximately two-thirds of the methods used for labour induction or augmentation were pharmacological only. Consistent with current guidelines for labour induction, 8–10 23–25 the greater the number of maternal and fetal clinical indications a woman had, the more likely her labour was to be induced, whereas women with any contraindication were less likely to be induced. Similarly, women with fewer clinical indications or contraindications for induction were less likely to undergo labour augmentation.…”

“…The current study largely expands previous analyses in other populations, 2 4 12–19 encompassing a comprehensive range of both maternal and fetal clinical factors in relation to labour induction and augmentation. Most studies have individually examined health complications in mothers and/or fetus, and reported associations of various clinical conditions, including hypertensive disorders in pregnancy and non-indications 8 10 such as anxiety, depression and urinary tract infection, with labour induction 2 4 12 13 or augmentation 18,19 . One of these studies also showed several contraindications (i.e.…”

“…placental abruption, placenta praevia, cord prolapse and breech or malpresentation) to be less likely to be associated with labour induction. 12 We considered and classified all recorded maternal and fetal clinical conditions as per guidelines for labour induction 8–10 23–25 and showed that fewer indications and any contraindications were less likely to be associated with labour induction and augmentation in the Indian study population, even after adjusting for maternal healthcare utilization, lifestyle and socio-demographic characteristics, thus highlighting generally good clinical practice among our study healthcare facilities. A very small number of women with contraindications were however induced (n=27) or augmented (n=15), where the contraindications were identified during antenatal visits or recorded as indications for emergency caesarean section, suggesting that clinicians may have potentially missed or not fully considered all pertinent information in medical records, or not adequately assessed women’s and their fetus’ health conditions before labour intervention.…”

“…The maternal and fetal clinical conditions were classified into four groups based on guidelines for labour induction from the WHO 23 , the National Institute for Health and Care Excellence (NICE) 24 , the American College of Obstetricians and Gynecologists (ACOG) 25 , and the Federation of Obstetric and Gynecological Societies of India (FOGSI) 8–10 : (i) two or more clinical indications, (ii) one clinical indication, (iii) no clinical indications and (iv) contraindication/s for induction. This was used to generate a categorical variable ‘induction- related clinical indications’.…”