Procedure Ready: Ob/Gyn

Induction of Labor

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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 

                •  

                Augmentation: AROM 

                 

                Failed IOL

                • Failure to reach active labor after 18+hrs ruptured on pitocin (definition varies 12-24hrs ruptured on pitocin) 
                • If reaches active labor (6+cm), no longer failed IOL, now arrest of dilation or descent 
                  • ...more
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                  Procedure Ready: Ob/GynBy Jennifer Doorey, MD, MS
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