Evidence-based labor management: induction of labor (part 2)

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Labor induction is frequently indicated for maternal, fetal, or obstetrical reasons.
• Pregnancy induction can be initiated at 39 weeks gestation.
• Predictive methods for cesarean delivery incidence post-induction lack sufficient sensitivity and specificity.

Purpose of the Study:

• To outline recommended protocols for labor induction.
• To provide guidance on the timing and methods for induction, including pharmacological and mechanical approaches.
• To establish guidelines regarding the duration of oxytocin infusion before considering cesarean delivery.

Main Methods:

• Recommends a combination of a 60- to 80-mL Foley catheter for 12 hours with either oral misoprostol (25 μg initially, then 25 μg every 2-4 hours, or 50 μg every 4-6 hours) or oxytocin infusion.
• Suggests considering membrane stripping at the start of induction.
• Proposes discontinuing oxytocin infusion once adequate contractions and 5-6 cm cervical dilation are achieved.
• Recommends oxytocin induction for term prelabor rupture of membranes if labor is not evident within 12 hours.
• Considers outpatient Foley ripening for low-risk women.

Main Results:

• No current prediction method accurately determines cesarean delivery rates after induction.
• Specific protocols involving Foley catheters, misoprostol, and oxytocin are detailed for effective labor induction.
• Guidelines are provided for managing oxytocin infusion duration, suggesting cesarean delivery should ideally occur after 18-24 hours of infusion and amniotomy.

Conclusions:

• Labor induction protocols should combine mechanical and pharmacological methods for optimal outcomes.
• Membrane stripping and outpatient Foley ripening are viable adjuncts for induction.
• Cesarean delivery should be judiciously timed, not performed before 15-18 hours of oxytocin infusion and amniotomy.