Elective, Marginal Inductions on the Rise

Until we do so, we should be aware that we may be complicating the uncomplicated.

ELSEVIER GLOBAL MEDICAL NEWS

Induction of Labor

The timing of parturition remains a conundrum in obstetric medicine in that the majority of pregnancies will go to term and enter labor spontaneously, whereas another portion will go post term and often require induction, and still others will enter labor prematurely.

The concept of labor induction, therefore, has become very important in obstetric management, especially in addressing pregnancies that either go post term or pregnancies that require induction because of medical complications in the mother.

Increasingly, however, patients are apt to have labor induced for their own convenience, for personal reasons, for the convenience of the physician, and sometimes for all of these reasons.

This increasingly utilized social option ushers in a whole new perspective on the issue of induction, and the question is raised about whether or not the elective induction of labor brings with it added risk and more complications.

It is for this reason that we decided to develop a Master Class feature on this topic. It gives us the important opportunity to examine and consider the pros and cons of labor induction, the timing of labor induction, and the advisability of the various conditions under which induction can and does occur.

This month's guest professor is Dr. William F. Rayburn, professor and chairman of the department of ob.gyn. at the University of New Mexico, Albuquerque. Dr. Rayburn is a maternal and fetal medicine specialist with a national reputation in this area.

Indications and Contraindications

Indications

Abruptio placentae

Chorioamnionitis

Fetal demise

Pregnancy-induced hypertension

Premature rupture of membranes

Postterm pregnancy

Maternal medical conditions (such as diabetes mellitus, renal disease, chronic pulmonary disease, chronic hypertension)

Fetal compromise (such as severe fetal growth restriction, isoimmunization)

Preeclampsia, eclampsia

Contraindications

Vasa previa or complete placenta previa

Transverse fetal lie

Umbilical cord prolapse

Previous transfundal uterine surgery

Special Attention

One or more previous low-transverse cesarean deliveries

Breech presentation

Maternal heart disease

Multifetal pregnancy

Polyhydramnios

Presenting part above the pelvic inlet

Severe hypertension

Abnormal fetal heart rate patterns not necessitating emergent delivery

Source: Adapted from ACOG Practice Bulletin No. 10, “Induction of Labor” (Nov. 1999).