ICD-9-CM 73.0-73.1 | ||
Labor induction is artificially stimulating childbirth.
Contents
Medical uses
Commonly accepted medical reasons for induction include:
Induction of labor in those who are either at or after term improves outcomes for the baby and decreases the number of C-sections performed.
Methods of induction
Methods of inducing labor include both pharmacological medication and mechanical or physical approaches.
Mechanical and physical approaches can include artificial rupture of membranes or membrane sweeping. The use of intrauterine catheters are also indicated. These work by compressing the cervix mechanically to generate release on prostaglandins in local tissues. There is no direct effect on the uterus.
Pharmacological methods are mainly using either dinoprostone (prostaglandin E2) or misoprostol (a prostaglandin E1 analogue)
Medication
Mechanical and physical approaches
When to induce
The American Congress of Obstetricians and Gynecologists has recommended against elective induction before 41 weeks if there is no medical indication and the cervix is unfavorable. However, recent studies contradict this view. One recent study indicates that labor induction at term or post-term reduces the rate of caesarean section by 12%, and also reduces fetal death. On the other hand, observational/retrospective studies have shown that non-indicated, elective inductions before the 41st week of gestation are associated with an increased risk of requiring a caesarean section. Randomized clinical trials have not been used to study this question. However, it has been found that multiparous women who undergo labor induction without medical indicators are not predisposed to cesarean sections. Doctors and patients should have a discussion of risks and benefits when considering an induction of labor in the absence of an accepted medical indiction.
Studies have shown a slight increase in risk of infant mortality for births in the 41st and particularly 42nd week of gestation, as well as a higher risk of injury to the mother and child. Due to the increasing risks of advanced gestation, induction appears to reduce the risk for cesarean delivery after 41 weeks gestation and possibly earlier.
Inducing labor before 39 weeks in the absence of a medical indication, like hypertension, IUGR, or pre-eclampsia, increases the risk of complications of prematurity including difficulties with respiration, infection, feeding, jaundice, neonatal intensive care unit admissions, and perinatal death.
The odds of having a vaginal delivery after labor induction are assessed by a "Bishop Score". However, recent research has questioned the relationship between the Bishop score and a successful induction, finding that a poor Bishop score actually may improve the chance for a vaginal delivery after induction. A Bishop Score is done to assess the progression of the cervix prior to an induction. In order to do this, the cervix must be checked to see how much it has effaced, thinned out, and how far dilated it is. The score goes by a points system depending on five factors. Each factor is scored on a scale of either 0-2 or 0–3, any score that adds up to be less than 5 holds a higher risk of delivering by cesarean section.
Criticisms of induction
Induced labor may be more painful for the woman. This can lead to the increased use of analgesics and other pain-relieving pharmaceuticals. These interventions have been said to lead to an increased likelihood of caesarean section delivery for the baby. However, studies into this matter show differing results. One study indicated that while overall caesarean section rates from 1990–1997 remained at or below 20%, elective induction was associated with a doubling of the rate of caesarean section . Another study showed that elective induction in women who were not post-term increased a woman's chance of a C-section by two to three times. A more recent study indicated that induction may increase the risk of caesarean section if performed before the 40th week of gestation, but it has no effect or actually lowers the risk if performed after the 40th week.
The most recent reviews on the subject of induction and its effect on Cesaerean section indicate that there is no increase with induction and in fact there can be a reduction.
The Institute for Safe Medication Practices labeled pitocin a “high-alert medication" because of the high likelihood of “significant patient harm when it is used in error.” Correspondingly, the improper use of pitocin is frequently an issue in malpractice litigation.