OB Induction

[Slevin]

Does anyone have a cheat sheet for risks vs benefits and indications vs contraindications for the various forms of labor induction?

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[BigSib]

Does anyone have a cheat sheet for risks vs benefits and indications vs contraindications for the various forms of labor induction?

May not be up to date. I don't practice OB anymore.


Indications for Induction (modified for the outpatient setting):1



Fetal demise

Gestational hypertension

SBP >140, DBP >90 associated with proteinuria ( ≥0.3 g/24 hrs)

HELLP syndrome

Eclampsia

PROM

Fetal compromise

BPP <6/10

Severe or asymmetric IUGR

Postterm pregnancy (>41 weeks gestation) [Note this is not ≥41 weeks gestation]


Situations for which induction may be considered :2



Fetal macrosomia (Infant >4500 grams by ultrasound)

Gestational diabetes >40 weeks gestation

Other conditions on a case-by-case basis


Criteria to be met prior to induction :



Accurate assessment of gestational age

FHT by Doppler for ≥30 weeks

Positive hCG for ≥36 weeks

CRL supporting a gestational age of ≥39 weeks

13-20 week US confirming a clinical gestational age of ≥39 weeks

Estimation of fetal weight

Assessment of fetal presentation

Calculation of Bishop score

If <6, induction should be preceded by cervical ripening

Discussion with patient of risks (vs. benefits) of induction

Uterine tachysystole

Hyperstimulation syndrome

Fetal heart rate decelerations

Uterine atony

Placental abruption

Uterine rupture

Documentation of indication for induction and discussion of risks/benefits


Acceptable ripening agents :



Balloon device (Foley)

Extra-amniotic saline infusion

Hygroscopic dilators

Prostaglandin E2 (Cervidil, Prostin, dinoprostone, or Prepidil)

Misoprostol


Acceptable induction agents :

Oxytocin

Misoprostol

Notes:
These may be considered on a case-by-case basis, but also need to be discussed with the faculty on call at the beginning of the induction (i.e., placement of ripening agent or admission for pitocin) for the date under consideration, as there may be differences in practice.

References:

Induction of Labor. ACOG Technical Bulletin #10. November, 1999.

Fetal Macrosomia. ACOG Technical Bulletin #22. November, 2000.

Gestational Diabetes. ACOG Technical Bulletin #30. September, 2001.

Kelly, AJ. Kavanagh, J. Thomas, J. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2, 2006.

Hofmeyr, GJ. Gulmezoglu, AM. Vaginal misoprostol for cervical ripening and induction of labour. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2, 2006.

Irion, O. Boulvain, M. Induction of labour for suspected fetal macrosomia. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2, 2006.

Boulvain, M. Stan, C. Irion, O. Elective delivery in diabetic pregnant women. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2, 2006.

Howarth, GR. Botha, DJ. Amniotomy plus intravenous oxytocin for induction of labour. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2, 2006.

Bricker, L. Luckas, M. Amniotomy alone for induction of labour. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2, 2006.

Crowley, P. Interventions for preventing or improving the outcome of delivery at or beyond term. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2, 2006.

Tenore J. Methods for cervical ripening and induction of labor. Am Fam Physician 2003;67(10):2076, 2078, 2083-4.

Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183(1):S1-S22.










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