Induction of Labor

Indications: 

Post-dates (42+wks) 

Late Term (41+ wks)

Elective 39+wks 

Diabetes

Hypertension 

Many more - check out ACOG Medically indicated delivery 

39week induction

ARRIVE Trial - Multicenter RCT showing benefit to 39wk IOL over expectant management to ~41wks 

Included 

Primips 

No medical indications for IOL prior to 40+5

Results 

IOL group had LOWER c-section rate than expectant group 

Neonatal composite outcome had a trend (not statistically significant) toward lower neonatal compilations in IOL group 

Conclusion

IOL at 39wks is as safe as expectant management without increased risks

Many pregnant people are now offered a 39wk IOL rather than waiting for spontaneous labor 

The IOL Process: 

Evaluate and Prep:

Full H&P

Ultrasound for position - Vertex

VE for cervical exam: dilation/effacement/Station, also position and consistency 

Calculate Bishops Score → help determine mode of IOL

Options for IOL: if biship score <8 for prime or <6 for multip, ripen first! 

Mechanical cervical ripening (balloon)

Chemical cervical ripening (misoprostol or cervidil) 

Best yet--both! 

Contractions (pitocin) 

Prime: Pitocin alone if Biship 8 or higher

Mulitp: Pitocin alone if bishop 6 or higher&n