June 09, 2023

Induction of Labor

18 minutes

Induction of labor is one of the most common procedures on L&D. This episode covers the indications (including the landmark ARRIVE trial for 39-week elective induction), the Bishop score for determining readiness, cervical ripening options, pitocin protocols, and the criteria for failed induction.

Show Outline:

Indications – Post-dates (42+wks), late term (41+wks), elective 39+wks, diabetes, hypertension, and many more per ACOG

ARRIVE Trial – Multicenter RCT showing 39wk IOL in low-risk primips had a LOWER c-section rate vs. expectant management to ~41wks, with a trend toward fewer neonatal complications. Many pregnant people are now offered a 39wk IOL.

Evaluate and Prep – Full H&P, ultrasound for vertex position, cervical exam (dilation/effacement/station/position/consistency), calculate Bishop score

Options for IOL

If Bishop <8 (primip) or <6 (multip) → ripen first!

Mechanical cervical ripening (balloon)

Chemical cervical ripening (misoprostol or cervidil)

Best yet – both!

Contractions (Pitocin) – Primip: alone if Bishop ≥8. Multip: alone if Bishop ≥6.

Augmentation – AROM (amniotomy)

Failed IOL – Failure to reach active labor after 18+hrs ruptured on pitocin (definition varies 12–24hrs). If she reaches active labor (6+cm), it's no longer failed IOL – now it's arrest of dilation or descent.

Resources/Links:

ACOG – Medically Indicated Late-Preterm and Early-Term Deliveries

Links:

ACOG – Medically Indicated Delivery: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/07/medically-indicated-late-preterm-and-early-term-deliveries

About the Speaker:

Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

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By Jennifer Doorey, MD, MS

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