ACOG technical bulletin summarizes current approaches for induction of labor

ACOG technical bulletin summarizes current approaches for induction of labor – American College of Obstetricians and Gynecologists

The American College of Obstetricians and Gynecologists (ACOG) has released a technical bulletin (ACOG Technical Bulletin no. 217, December 1995) that summarizes current approaches for induction of labor. The bulletin describes the indications and contraindications for induction of labor, requirements for induction and the acceptable methods of labor induction, including cervical ripening, stripping of membranes, amniotomy, oxytocin and serial inductions. The following list of indications and contraindications for induction of labor were excerpted from the ACOG bulletin.

Indications

Induction of labor is a therapeutic option when the benefits to either the mother or fetus outweigh those of expectant management. The risks and benefits must be determined before induction of labor can be considered.

Indications for inducing labor include, but are not limited to, the following situations:

*Pregnancy-induced hypertension

*Premature rupture of membranes

*Chorioamnionitis

*Suspected fetal jeopardy (e.g., severe fetal growth retardation, isoimmunization)

*Maternal medical problems (e.g., diabetes, renal disease, chronic pulmonary disease)

*Fetal demise

*Logistic factors (e.g., risk of rapid labor, distance from hospital, psychosocial indications)

*Postdate pregnancy

Contraindications

Contraindications to labor induction include, but are not limited to, the following factors:

*Placenta or vasa previa

*Transverse fetal lie

*Prolapsed umbilical cord

*Prior classical uterine incision

*Active genital herpes infection

There are few absolute contraindications to labor, however, because there may be certain clinical situations in which exceptions make induction appropriate (e.g., active genital herpes infection in the presence of fetal demise).

Although some obstetric conditions may require special attention, they do not necessarily constitute contraindications to labor induction:

*Multifetal gestation

*Polyhydramnios

*Maternal cardiac disease

*Abnormal fetal heart rate patterns not requiring emergency delivery

*Grand multiparity

*Severe hypertension

*Breech presentation

*Presenting part above the pelvic inlet

A trial of labor is not contraindicated in women with one or more previous low transverse cesarean deliveries. Risks of instrumental vaginal delivery, uterine scar dehiscence, transfusion, birth trauma and poor neonatal outcome have not been shown to be increased with induced rather than spontaneous labor as long as uterine activity is monitored closely.

Labor should be induced only after both the mother and fetus have been examined thoroughly. The patient must give informed consent. A careful explanation of the process and methods should be given to the mother. An assessment of fetal maturity is often important.

For information about ACOG technical bulletins, contact ACOG, 409 12th Street, S.W, Washington, DC 20024-2188; 800-762-9964.

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